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June 2015

35-year-old female presented to the dental clinic with desquamative gingiva and severe ragged erosions on the palate and buccal mucosa. Biopsy of the lesion showed intraepithelial separation, occurring just above the basal cell layer of the epithelium. Direct immunofluorescence examination of tissue submitted in Michel’s solution revealed IgG, IgM and C3 localization in the intercellular spaces between the epithelial cells. What is the most likely diagnosis?

 

INCORRECT.

Histopathologic feature of mucous membrane pemphigoid shows a split between the surface epithelium and the underlying connective tissue in the region of the basement membrane. Direct immunofluorescence studies of perilesional mucosa show a continuous linear band of immunoreactants (IgG, C3 and occasionally IgA and IgM) at the basement membrane zone in nearly 90% of affected patients.

 

CORRECT.

 

 

 

INCORRECT.

Subepithelial or intraepithelial vesiculation may be seen in association with necrotic basal keratinocytes with mixed inflammatory infiltrate. Because the immunopathologic features are also nonspecific, the diagnosis is often based on the clinical presentation and the exclusion of other vesiculobullous disorders.

 

 

INCORRECT.

Chronic ulcerative stomatitis is similar to those of lichen planus. The diagnosis is essentially based on its characteristic immunopathologic pattern. With direct immunofluorescence studies, autoantibodies (usually IgG) that are directed against the nuclei of stratified squamous epithelial cells in the basal and parabasal regions of the epithelium are detected.

 

 

INCORRECT.

The histopathology of lichen planus shows destruction of the basal cell layer of the epithelium, accompanied by an intense, bandlike infiltrate of predominantly T lymphocytes immediately subjacent to the epithelium. The immunopathologic features of lichen planus are nonspecific. Most lesions show the deposition of a shaggy band of fibrinogen at the basement membrane zone.

 


June 2015 References

Neville B, Damm DD, Allen CM, Bouquot J. Oral and Maxillofacial Pathology, 4th Edition, W.B. Saunders Co.; 2015

 


May 2015

62-year-old female presented to the dental clinic with burning sensation in the mouth, especially the tongue. Clinically, the tongue exhibited erythroleukoplakic areas where the leukoplakic regions could be rubbed off. What is the most likely diagnosis?

 

INCORRECT.

Also known as perlèche, it involves the angles of the mouth (angular is characterized by erythema, fissuring, and scaling).

 

 

INCORRECT.

Chronic hyperplastic candidiasis is characterized by a white patch that cannot be removed by scraping. Such lesions are usually located on the anterior buccal mucosa and cannot clinically be distinguished from a routine leukoplakia. The diagnosis is confirmed by the presence of candidal hyphae associated with the lesion and by complete resolution of the lesion after antifungal therapy.

 

 

INCORRECT.

Also known as “antibiotic sore mouth”, erythematous candidiasis usually follows a course of broad-spectrum antibiotic therapy. Patients often complain that the mouth feels as if a hot beverage had scalded it. This burning sensation is usually accompanied by a diffuse loss of the filiform papillae of the dorsal tongue, resulting in a reddened, “bald” appearance of the tongue.

 

 

CORRECT.

Also known as thrush, it is characterized by the presence of adherent white plaques that resemble cottage cheese or curdled milk on the oral mucosa. The white plaques are composed of tangled masses of hyphae, yeasts, desquamated epithelial cells, and debris that can be scraped off. The underlying mucosa may appear normal or erythematous. Antibiotic exposure is typically responsible for an acute (rapid) expression of the condition; immunologic problems usually produce a chronic (slow-onset, long-standing) form.

 

 

INCORRECT.

More commonly known as “denture stomatitis”, it is often classified as a form of erythematous candidiasis. This condition is characterized by varying degrees of erythema localized to the denture-bearing areas of a maxillary removable dental prosthesis. The condition is rarely symptomatic. Usually the patient admits to wearing the denture continuously, removing it only periodically to clean it. The denture typically shows much heavier colonization by yeast than the palatal mucosa.

 


May 2015 References

Neville B, Damm DD, Allen CM, Bouquot J. Oral and Maxillofacial Pathology, 4th Edition, W.B. Saunders Co.; 2015

 


April 2015

A 25-year-old male presented to the dental clinic with a chief complaint of intermittent soreness in the mouth for several months. The patient has no significant medical history and does not take any medications. Intraoral examination revealed lace-like, white striations on right and left buccal mucosa. The lesion cannot be wiped off. No other findings noted. What is the most likely diagnosis?

 

INCORRECT.

 

 

 

INCORRECT.

Though allergic contact stomatitis has several clinical features, the patient did not have any history of recent dental restorations or new medicaments.

 

 

CORRECT.

It is immunologically mediated mucocutaneous disorder. It occurs in middle-aged patients with female predominance. Skin lesions appear as purple, pruritic, polygonal papules. Reticular type has no symptoms and involves posterior buccal mucosa bilaterally. Other oral mucosal surfaces involved are lateral and dorsal tongue, gingiva, palate and vermillion border. White lesions appear as papules. They can wax and wane. For asymptomatic cases, no treatment required. Topical or systemic corticosteroids recommended for symptomatic patients.

 

 

INCORRECT.

Chronic nibbling produces lesions most frequently located on buccal mucosa. It is found in people under stress or psychological conditions. Clinically, it can be bilateral or unilateral. It appears as thickened, shredded, white areas combined with intervening zones of erythema, erosion or focal traumatic ulceration. Areas of white mucosa show irregular ragged surface.  Altered mucosa located in mid-portion of anterior buccal mucosa along occlusal plane. No treatment is required.

 

 

INCORRECT.

Linea alba is a common alteration of buccal mucosa which is associated with pressure, frictional irritation, sucking trauma from facial surface of teeth. Clinically it appears as white line (usually bilateral) and may be scalloped. It is located on buccal mucosa at level of occlusal plane of adjacent teeth. No treatment is required.

 


April 2015 References

Neville B, Damm DD, Allen CM, Bouquot J. Oral and Maxillofacial Pathology, 3rd Edition, W.B. Saunders Co.; 2009