immunologic diseases

immunologic diseases

1. lichenoid contact reaction from dental resorative materialz

   • hypersensitivity reaction to dental material type 4
   • resembles lichen planus (histopathologically)
   • acute reaction to mercury in amalgam rare
     • erythemaouts pruritic of oral mucosa and facial skin
   • chronic
     • affects buccal mucosa and lateral border of tongue
     • area of contact in fomr of white or erythemaots lesion with or without stria resemble lichen planus

2. orofactial granulomatous

   • idiopathic disorder
   • clinical presentation
     • lips most common locaiton chelitis granulomatosa
     • non tender perseient swelling
     • intraoral edem ulcers papules
   • melkersson rosenthal sydrome
     • facial paralyis, fissured tongue, chelitis granukomatosa
   • histopathology
     • non caseating granilomtau infllamtion
       • epitheloid histiocytes, lympocytes, multinucleated giant clels.
     • specail stains negative for organnism and foreing mateiral

3. granulomatosis with polyangiitis wgener granulomatosisi

   • begins localized
   • classic
     • involve upper/lower respirarory tract in untreated renal involvemtne
   • limited
     • respiratory problems without renal involvement
   • superficial
     • skin and mucosa lesions
       • systemic involvement slow to develop
   • clinical and oral findings
     • nasal drainage
     • chronic sinus pain
     • saddle nose deformity
     • strawberry ginigivitis early manifestation
     • non specidic oral ulcerations palatal perforation from ulceraitions
   • iindirect immunofluresece for neutrophils testing
     • map anca
     • pr3- anca
   • treatment
     • cyclophsamide and prednisone

4. BEHCET SYNDROME

   • SYSTEMIC VASUCLITIS
   • linked to HLA b51
   • apthouls ulcer
   • genital ulcerations 75% of cases
   • ocular involvement
   • artritis self limiting

5. Angioedema quincke disease

   • diffuse edematous swelling of soft tissue
   • causes
     • type 1 hypersensistivity igE
     • contact allergic reaction
     • drugs ACE inhibotrs occus within hours of use
     • activation of coplement pathway
       • hereditary pr acquired type 1 c1 can not become c1 esterase
       • type !! c1 inh is dysfunctional
   • clinical features
     • rapid onset
     • soft non tender tissue swelling
     • affects face , lips tongue, pharynx, ;arynx
     • itching and erythema
   • treatment
     • resolves
     • anithistimains and coritcosteoirs
     • cease ace inhibitors if cause after discusing with physciaan

6. apthous ulcer

   • recurrent apthout stomatitis
     • Major Apthous Ulcer
       • Suttons Disease/ Periadentitis Mucosa NEcrotia REcurrens
         • 1-10 lesions per episode (1-3cm)
           • larger
         • 2-6 weeks to heal with scarring
         • occurs on SOFT palate, tonsils , labial mucosa
     • Herpetiform Apthous Ulcer
       • adulthood
       • resembles primary herpes
       • greater numbers and frequency
       • coalese to form large ulcerations
       • heal within 7-10 days
       • occur in on ANY surface
       • topical steroids treatment
     • Minor Apthous Ulcer
       • MOST COMMON
       • Mikulicz apthae
       • 80% begin in cildren
       • 3-10 mm in size 1-5 episode
       • heal within in 7-14 days
       • found on non keratized tissue
         • buccal labial venrtral tongue vestibule soft palate floor of mouth
       • well defined border
   • SYMPTOMS
     • prodromal symptoms
       • burning itching red macule
     • ulceration yellow white with red border

7. periooral dermatitis

   • perioficial dermatitis
   • idiopathic but assocaited with use of potent topical steroids
   • clinical features
     • erthematous papules , paulopustules , papulovesicle
   • upper lower lipps skin surrounding vermillion border
   • area adjacent to vermillion border spared
   • pruitis and burning occur

8. allerfgic contact stomatitis

   • reaction to various agents
   • acute presentation of mucosa
     • burning, visiblel redness to bright red with or withoud edema , itchin stingin tingling
   • chronic presentation
     • erythematous
     • hyperkerotic
     • desqyamtion of epitheluium if toothpast involved

9. mucosal reactions to systemic drugs

   • Type A augemented reaction 80%
   • Expected pharmacology reaction
   • type B Bizarre reaction
     • immune mediated effects
   • Clinical features
     • anaphylactic stomatitis reactions
       • seen with skin leasion or symptoms of anaphylaxis
     • fixed drug reactions
       • buccal mucosa
       • develop into vesiculoerosive lesions
       • localized areas of erytheme and edema
     • lichenoid lupus pemphigoid pempghius like reactios
       • posterior buccal mucosa and lateral border of tongue common loactions

10. Sarcoidosis

    • multi system granulomatous disorder
    • 10-17 times mor in black than white
    • Lymph nodes, lungs
    • eyes
    • skin
    • salivary glands
    • acute form
      • lofgren's syndome
        • rythema nodosum
        • bilateral hilar lymphadenopathy
        • arthralgia
      • herfordt's syndome
        • uveopartodi fever
        • parotid elnargemtn
        • anteroior uveitis facial paralyis fever
    • histopathology
      • granulomatous inflammation
    • diagonos
      • chest radiograph
      • elevated serum aCE levels
      • parotid gland biopsy
    • resolve after 2 years no treatment

11. contact stomatitis artificial cinnamon flavoriing

    • pain and burning very common
    • toothpaste diffuse pattern
      • affects gingiva
      • resemble plasma cell ginigivitis
    • chewing gum candy localized
      • affects buccal mucosa along occlusal plane hyperkaeratosis
        • affects lateral border of tongue resembles OHL