Chapter 7 Pictures
Abrasion of Teeth with Notching
-Biting surface of teeth are abraded or notched by recurrent trauma (holding nails or opening bobby pins). Sides of teeth show normal contours size and space of teeth are unaffected.
-Results from excessive exposure to sunlight and affects primarily the lower lip
Acute Necrotizing Ulcerative Gingivitis
-An uncommon form of gingivitis occurs suddenly in adolescents and young adults and is accompanied by fever, malaise, and enlarged lymph nodes. Ulcers develop in the interdental papillae, then necrotizing process spreads along the gum margins where grayish pseudomembrane develops. Red painful gums bleed easily and breath is foul.
Acute Otitis Media with Purulent Effusion
-Caused by bacterial infection. Symptoms include earache, fever, and hearing loss. The eardrum reddens, loses landmarks, and bulges laterally, toward examiner's eye. Hearing loss is of conductive type. Acute purulent otitis media is much more common in children than in adults.
-A diffuse, nonpitting, tense swelling of the dermis and subcutaneous tissue. Develops rapidly, and typically disappears over hours or days. Although usually allergic in nature, angioedema does not itch
-Starts with softening of the skin at the angles of the mouth followed by fissures. May be due to nutritional deficiency or, more commonly, to over closure of the mouth, as with people with no teeth or ill-fitting dentures. Often leads to secondary Candida infection, as seen here
Aphthous Ulcer (Canker Sore)
- Painful, round or oval ulcer that is white or yellowish gray and surrounded by a halo of reddened mucosa. Single or multiple, heals in 7-10 days, may recur.
Attrition of Teeth; Recession of Gums
-In elderly people, the chewing surfaces of the teeth have been worn down by repetitive use so the yellow-brown dentin becomes exposed-process called attrition. The recession of the gums also exposes the roots, giving a "long in the tooth" appearance.
Basal Cell Carcinoma
- this raised nodule shows lustrous surface and telangiectasia. Rarely metastasizes.
-Viral infection characterized by painful hemorrhagic vesicles that appear on the tympanic membrane, ear canal, or both. Symptoms include earache, blood-tinged discharge, and hearing loss of conductive type. Several different viruses may cause, including mycoplasma.
-Thick white coating from Candida infection. Red surface is where the coat was scraped off. Infection may occur without coating. Seen in the immunosuppressed.
Carcinoma of the Lip
-Carcinoma usually affects the lower lip (like actinic cheilitis). May appear as scaly plaque, an ulcer with or without a crust, or a nodular lesion. Fair skin and prolonged exposure to the sun are risk factors.
Carcinoma, Floor of the Mouth
-Common location for carcinoma. Also, the medially reddened area, called erythroplakia, suggests possible malignancy.
Chancre of Syphillis
-Lesion of primary syphilis may appear on the lip rather than on the genitalia. A firm, buttonlike lesion that ulcerates and may become crusted. Use Gloves!
-Chronic inflammatory lesion starts as a painful, tender papule on the helix or antihelix.
Shown is the later stage of ulceration and crusting. Biopsy needed to rule out carcinoma.
-Formerly called a sebaceous syst. A dome-shaped lump in the dermis forms a benign closed firm sac attached to the epidermis. Blackhead may be visible. Usually either 1)epidermoid cyst common on face and neck or 2) pilar (trichilemmal) cyst, common on scalp
Diffuse Enlargement of Thyroid
- Includes the isthmus and lateral lobes; no discretely palpable nodules. Causes include Fraves' disease, Hashimoto's thyroiditis, and endemic goiter.
-An acute infection caused by Corynebacterium diphtheriae. Now rare, but still important. Throat is dull red, and gray exudate present. Airway may become obstructed. Prompt diagnosis may lead to life-saving treatment.
Erosion of Teeth
-May be eroded by chemical action. This picture shows erosion of the enamel from lingual surfaces of the upper incisors, exposing the yellow-brown dentin, the result of recurrent regurgitation of stomach contents, as in bulimia.
-Red throat has a white exudate on the tonsils. This with fever and enlarged cervical nodes, increases the probability of group A streptococcal infection or infectious mononucleosis.
Fordyce Spots (Fordyce Granules)
-Normal sebaceous glands that appear as small yellowish spots in the buccal mucosa or on the lips.
-Benign condition when dorsum shows scattered smooth red areas denuded of papillae. Together with normal rough coated areas, they give a maplike pattern that changes over time.
-Swollen gums into heaped-up masses that may even cover the teeth. Causes include dilantin therapy (seen here), puberty, pregnancy, and leukemia.
-whitish raised areas with feathery or corrugated pattern, most often affect the sides of the tongue. These cannot be scraped off (unlike candidiasis). Seen with HIV and AIDS
-"Hairy" yellowish to brown or black elongated papillae on the tongue's dorsum. This benign condition may follow antibiotic therapy; may also occur spontaneously.
Herpes Simplex (Cold Sore, Fever Blister)
-Herpes Simplex Virus (HSV) produces recurrent and painful vesicular eruptions of the lips and surrounding skin. As small cluster of vesicles break, yellow-brown crust form, and heal within 10-14 days.
Hereditary Hemorrhagic Telangiectasia
-Multiple small red spots on the lips. Spots may be visible on the face, hands, and in the mouth. Spots are dilated capillaries and may bleed when traumatized. Affected people often have nosebleeds and gastrointestinal bleeding.
-Smaller and more widely spaced teeth than normal and are notched on their biting surfaces. Sides of teeth taper toward the biting edges. Upper central incisors are most often affected. Sign of congenital syphilis
Kaposi's Sarcoma in AIDS
-Deep purple color of lesion, though may not always be present. May be raised or flat. Among people with AIDS, the palate is a common site for this tumor.
-Firm, nodular, hypertrophic mass of scar tissue extending beyond the area of injury. May develop in any scarred area, but more common on shoulders and upper chest. More common in darker-skinned people. Recurrence may follow treatment.
-Early sign of measles (rubeola). Small white specks resemble grains of salt on a red background. Usually on buccal mucosa near 1st or 2nd molars. The rash of measles appears within a day.
Large Normal Tonsils
-Normal tonsils may be large without being infected, especially in children. Their color is pink. The white marks seen are light reflections, not exudate
-Persisting painless white patch in the oral mucosa. Patches of any size raise the possibility of malignancy and require a biopsy.
-A thickened white patch may occur anywhere in the oral mucosa. This example is buccal mucosa, results of frequent chewing of tobacco, a local irritant. May lead to cancer.
-Common among teenagers and young children. Gingival margins are reddened and swollen, and the interdental papillae are blunted, swollen, and red. Often gums bleed when brushing teeth. Plaque not readily visible.
Mucous Patch of Syphilis
-Painless lesion in the secondary stage of syphilis is highly infectious. Slightly raised, oval, and covered by a grayish membrane. May be multiple and occur elsewhere in the mouth.
-Enlarged thyroid gland with two or more nodules suggests a metabolic rather than neoplastic process. Positive family history and continuing nodular enlargement are additional risk factors for malignancy.
Normal Eardrum (Right)
-Tympanic membrane is pinkish gray. Malleus is lying behind the upper part of the drum. Above the short process lies the pars flaccida. The remainder of the drum is the pars tensa. From the umbo, the bright cone of light fans anteriorly and downward. Posterior to the malleus, part of the incus is visible behind the drum. The small blood vessels along the handle of the malleus are normal.
Perforation of the Drum
-Holes in the eardrum that usually results from purulent infection of the middle earl. Classified as (1) Central Perforations, which do not extend to the margin of the drum and (2) Marginal Perforations, which do involve the margin. Picture illustrates a common central perforation.
-Small red spots that result when blood escapes from capillaries into the tissues. Petechiae in the buccal mucosa (as shown), are often caused by accidentally biting the cheek. Oral petechial may also be due to infection, decreased platelets, or trauma.
-Pigmented spots on the lips are more prominent than freckling of the surrounding skin. Pigment in the buccal mucosa helps to confirm the diagnosis. Pigmented spots may also be found on the face and hands. Multiple intestinal polyps are often associated.
-Redness is diffuse and intense. Patient would complain of a scratchy or sore throat. Causes include several kinds of viruses and bacteria. Two common causes are group A streptococci and Epstein-Barr virus (infectious mononucleosis). If no fever, exudate, or enlargement of cervical lymph nodes, chances of infection by these two causes are very small.
-Redness and vascularity of the pillars and uvula are mild to moderate. Reddened throat without exudate.
Pregnancy Tumor (Epulis, Pyogenic Granuloma)
-Gingival enlargement may be localized, forming a tumorlike mass that usually originates in an interdental papilla. It is red, soft, and usually bleeds easily. Estimated incidence of this lesion in pregnancy is ~1%.
-With chronic rheumatoid arthritis, small lumps on the helix or antihelix . Ulcerations may result from repeated injuries. Additional nodules may be seen on the hands, surface of ulna distal to the elbow, knees, and heels.
-Caused by viral upper respiratory infections (otitis media with serous effusion) or by sudden changes in atmospheric pressure as from flying or diving (otitic barotrauma). Eustachian tube cannot equalize the air pressure in the middle ear with that of the outside air. Symptoms include fullness, and popping sensations, mild conduction hearing loss, and perhaps some pain. Amber fluid behind the eardrum is characteristic.
Single Nodule Thyroid Enlargement
-May be a cyst, benign tumor, or one nodule within a multinodular gland. Raises the question of malignancy. Risk factors are prior irradiation, hardness, rapid growth, fixation to surrounding tissues, enlarged cervical nosed, and occurrence in males.
Smooth Tongue (Atrophic Glossitis)
-Smooth and often sore tongue that has lost its papillae. It suggests deficiency in riboflavin, niacin, folic acid, vitamin B12, pyridoxine, iron, or treatment with chemotherapy.
Thrush on the Palate (Candidiasis)
-A Yeast infection due to Candida. Shown on palate, but may occur elsewhere in mouth. Thick, white plaques are somewhat adherent to the underlying mucosa. Predisposing factors include (1) prolonged treatment with antibiotics or corticosteroids and (2) AIDS
-Deposit of uric acid crystals characteristic of chronic tophaceous gout. Appears as hard nodules in the helix or antihelix and may discharge chalky white crystals through the skin. Usually develops after chronic sustained high blood levels of uric acid. May also appear near joints, hands, feet, and other areas.
-Rounded bony growths on the inner surfaces of the mandible are typically bilateral, asymptomatic, and harmless.
-Midline bony growth in the hard palate that is fairly common in adults. Size and lobulation vary. Though alarming, it is Harmless.
-Deposition of hyaline material within the layers of the tympanic membrane that sometimes follows a severe episode of otitis media. Does not usually impair hearing and is seldom clinically significant. Chalky white patch with irregular margins are typical.
-Small purplish or blue-black round swellings appear under the tongue with age. The dilations of the lingual veins have no clinical significance.