Contents 2020 Dermatologic-Clinics

Oral Medicine in Dermatology
Contents
Preface: Oral Medicine in Dermatology: An Interprofessional Partnership xi
Eric T. Stoopler and Thomas P. Sollecito
Clinical Evaluation and Anatomic Variation of the Oral Cavity 399

Sunday O. Akintoye and Mel Mupparapu
Clinicians should be knowledgeable about the anatomy of the oral cavity and varia-
tions of normal because of oral and systemic health connections. This article pre-
sents an overview of normal and variations of normal anatomy of the oral cavity.
Common Dental and Periodontal Diseases 413

Joel M. Laudenbach and Satish S. Kumar
Oral health is a critical component of overall health and well-being. Dental caries and
periodontitis are two of the most common oral diseases and, when not treated, can
have irreversible sequelae and overall psychosocial and physiologic impact on indi-
viduals, diminishing quality of life. The burden of advanced dental caries and peri-
odontal disease leading to tooth loss is severe. Physicians and allied medical
professionals can help in early detection of dental caries, abscess, and periodontal
diseases and initiate management followed by prompt referral to dental colleagues.
Oral Biopsy Techniques 421

Rabie M. Shanti, Takako Tanaka, and David C. Stanton
Squamous cell carcinoma makes up 90% of cases of oral cancer. However, a

myriad of premalignant, inflammatory, and immune-based conditions can manifest
as oral mucosal lesions. Biopsy of these lesions shares many of the principles of
cutaneous lesions. Biopsy of oral mucosal lesions is a procedure that is safely per-
formed in most cases in the outpatient ambulatory setting using local anesthesia.
Special considerations should be taken depending on the presumed diagnosis
based on physical examination. Its clinical relevance depends on a sound clinico-
pathologic assessment of the patient’s condition. This article reviews specific con-
siderations for biopsy of oral mucosal lesions.
Oral Granulomatous Disease 429

Faizan Alawi, Bridget E. Shields, Temitope Omolehinwa, and Misha Rosenbach
Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is

triggered by an array of infectious and noninfectious agents, and may be localized or
a manifestation of systemic, disseminated disease. As in the skin, oral manifesta-
tions of granulomatous inflammation are often nonspecific in their clinical appear-
ance. Thus, in the absence of overt foreign material or a recognizable infectious
agent, identifying the underlying cause of the inflammation can be challenging.
This article highlights various conditions known to induce granulomatous inflamma-
tion within the oral soft tissues.
viii Contents
Acute Oral Lesions 441

Katherine France and Alessandro Villa
A variety of acute oral lesions may be encountered in the scope of dermatology. Oral
lesions may be single or multiple; may arise secondary to infectious, immune,
congenital, medication use, or idiopathic causes; and may take a variety of forms.
A thorough evaluation of the oral cavity is required to assess patients with oral le-
sions. Affected patients may be monitored, treated, or referred to an appropriate
specialist for further management as needed. Many acute oral lesions are self-
limiting in nature and patients may require only assessment and reassurance.
Several common acute oral lesions are discussed in this article.
Chronic Oral Lesions 451

Alaa F. Bukhari, Arwa M. Farag, and Nathaniel S. Treister
Chronic oral mucosal lesions can be associated with several mucocutaneous dis-
eases. This article reviews the autoimmune and immune-mediated, reactive, ge-
netic, and infectious diseases that may present with chronic oral and/or
cutaneous manifestations and provides a rational approach to diagnosis and
management.
Oral Hypersensitivity Reactions 467

Jacob P. Reinhart, Eric T. Stoopler, and Glen H. Crawford
Allergic contact hypersensitivity reactions of the oral mucosa pose a significant

medical concern for some patients. Oral hypersensitivity reactions can result from
a vast number of allergenic chemicals, but occur commonly from dental materials,
flavorings, and preservatives. Clinical presentation is varied and often overlaps
with other oral conditions, complicating their diagnosis and management. The
most common clinical entities associated with oral hypersensitivity reactions are
oral lichenoid reactions and allergic contact cheilitis. In addition to reviewing these
conditions and their most common corresponding allergens, this article summarizes
the pathogenesis of oral hypersensitivity reactions and addresses patch testing
pearls.
Burning Mouth Syndrome 477

Brittany Klein, Jaisri R. Thoppay, Scott S. De Rossi, and Katharine Ciarrocca
Burning mouth syndrome is a chronic condition characterized by an intraoral burning

sensation in the absence of a local or systemic cause.
Pigmented Lesions 485

Eugene Ko and Neeraj Panchal
Oral pigmented lesions have a wide range of clinical presentations, some of which
correlate with cutaneous pigmented lesions. This article highlights these correlates
and underscores important differences that can potentially have clinical impact.
Moreover, given a nonspecific presentation of an oral pigmented lesion, the article
provides a reference to aid clinicians with differential diagnoses based on clinical
features. This article is an overview of pigmented lesions of the oral cavity, including
localized reactive pigmented lesions, neoplastic pigmented lesions, and pigmented
lesions as sequelae of a systemic disease.
Contents ix
Oral Manifestations of Systemic Diseases 495

Joel J. Napeñas, Michael T. Brennan, and Sharon Elad
Signs and symptoms representative of a systemic condition can manifest in the oral
cavity and orofacial region. Such conditions may be previously diagnosed, or the or-
ofacial manifestation may be the presenting sign of an acute or chronic systemic
condition not previously diagnosed. Pathologic processes in the mouth, jaws, and
contiguous structures could have a direct and indirect impact on the patient’s overall
systemic condition. Moreover, systemic conditions may result in compromised func-
tion of the orofacial region or impact patients’ oral health profile. This article reviews
selected systemic conditions that present or impact on the oral cavity and orofacial
region.
Oral Potentially Malignant Disorders and Oral Cavity Cancer 507

David Ojeda, Michaell A. Huber, and Alexander R. Kerr
Oral and pharyngeal cancer incidence is increasing and largely related to an in-
crease in HPV1 oropharynx cancers. Early detection of oral cavity cancers leads
to improved survival, and opportunistic screening by trained clinicians is recommen-
ded by the American Dental Association and the American Academy of Oral Medi-
cine. A visual and tactile oral examination followed by biopsy with histologic
evaluation of oral potentially malignant disorders remains the gold standard to
establish a definitive diagnosis. Evidence-based management of oral cavity cancer
requires a multidisciplinary team and may include surgery, radiation, chemotherapy,
or immunotherapy. The management oral epithelial dysplasia is not well defined.
Adverse Drug Events in the Oral Cavity 523

Anna Yuan and Sook-Bin Woo
Adverse reactions to medications are common and may have a variety of clinical
presentations in the oral cavity. Targeted therapies and new biologic agents have
revolutionized the treatment of cancers, autoimmune diseases, and inflammatory
and rheumatologic diseases but have also been associated with adverse events in
the oral cavity. This review describes the most common clinical presentations of
oral mucosal reactions to medications, namely hyposalivation, lichenoid reactions,
ulcers, bullous disorders, pigmentation, fibrovascular hyperplasia, reactive kera-
tosis, dysesthesia, osteonecrosis, infection, angioedema, and malignancy.
Dental Considerations in Patients with Oral Mucosal Diseases 535

Wesley Sherrell, Bhavik Desai, and Thomas P. Sollecito
Oral mucosal diseases represent a significant health care burden, rendering a com-
plex patient population in which interdisciplinary care among dermatologists, pri-
mary dental providers, and dental specialists is required for optimal care. Oral
mucosal diseases often cause painful ulceration and blistering which can impede
a patient’s ability to perform dental home care and the dental professional’s ability
to deliver routine and complex treatment. It is crucial to consider the environment
of the oral cavity. It is paramount to be aware of the potential side effects that certain
medications may cause and the possible interactions with other medications the pa-
tient is using.

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Contents 2020 Dermatologic-Clinics

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Oral Medicine in Dermatology

Clinical Evaluation and Anatomic Variation of the Oral Cavity 399

Common Dental and Periodontal Diseases 413

Oral Biopsy Techniques 421

Squamous cell carcinoma makes up 90% of cases of oral cancer. However, a

Oral Granulomatous Disease 429

Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is

Acute Oral Lesions 441

Chronic Oral Lesions 451

Oral Hypersensitivity Reactions 467

Allergic contact hypersensitivity reactions of the oral mucosa pose a significant

Burning Mouth Syndrome 477

Burning mouth syndrome is a chronic condition characterized by an intraoral burning

Pigmented Lesions 485

Oral Manifestations of Systemic Diseases 495

Oral Potentially Malignant Disorders and Oral Cavity Cancer 507

Adverse Drug Events in the Oral Cavity 523

Dental Considerations in Patients with Oral Mucosal Diseases 535

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