01: Top 30 Lecture Flashcards
What are the 3 results for a region during a Head and Neck Exam
Normal
Variant of Normal
Abnormal
Once you find the pathology what are the “Sieve” indicators related to the patient
Age
Gender
Race
Once you find the pathology what are the “Sieve” indicator related to the pathology itself
Color Size Location Morphology Radiographic
What color is leukoplakia
White
leukoplakia is a clinical term, so what does it mean?
A white lesion in the oral cavity only
It doesn’t not rub off
Why are white lesions white?
Because there is something blocking out the redness of the underlying vascular tissue
What types of things could be blocking the view of the vascular tissue?
Keratin Microbial colony Scar tissue Necrosis etc.
What White Lesions can be wiped off?
Materia Alba White coated tongue Burn (Thermal, Electrical, etc.) Pseudomembranous candidiasis Tooth Paste
What is materia alba
It is basically dental plaque that isn’t on the tooth
What is white coated tongue
Basically materia alba on the tongue
Asymptomatic
Can be brushed/scraped from the tongue
What are most oral burns caused by
Microwaved food
Why are burns white
White area is a scab that can be pulled off, bright red on periphery is healing tissues.
How do electrical burns differ from other oral burns
They often come from kids biting electrical cords
Why do some people get aspirin burns in the mouth?
People get a toothache and they have been told that if they put an aspirin next to the tooth it would work better than swallowing it
Why does aspirin cause an acid burn
Aspirin has a pH of 2
What is the treatment of an aspirin burn
Discontinuance of ASA
What other chemicals can cause “Aspirin” burns
Hydrogen peroxide
Silver nitrate
Phenol
some Endo Materials
How does toothpaste/mouthwash overdose cause a white lesion
Chronic overuse of some toothpaste can cause acid burn
Listerine is up to 25% alcohol that is also able to burn tissues
How can a cotton roll burn develop?
The cotton over time dessicated the epithelium and killed it by drying
What is thrush
Oral candidiasis in babies
Which is infective, candida spores or hyphae
Hyphae
What are the other forms and presentations of candidiasis
White Pseudomembranous
Thrush
Angular Chelitis
What is angular chelitis
Candidiasis on the corner of the mouth
What is Central Papillary Atrophy of the Tongue
Candidiasis on the part of the tongue that is not self cleansing
How do you treat Candidiasis?
Anti-fungal medicine
What is a troches
Medicine delivery that is time released like a life saver
What is Nicotine Stomatitis
White hyperkeratotic palate secondary to smoking, usually a pipe or cigar. Likely related to the heat
Who typically gets Nicotine Stomatitis
Males over 45
What should you document from your H&N exam if everything is normal?
Just that you did complete a head and neck exam and everything was normal!
What should you chart if you discover a lesion that is a variant of normal?
Details about the lesion and what exactly the variation is
What should you chart if you discover an abnormal lesion
Chart findings and then follow the protocol set forth in your standards of care documentation
Why might this course’s Top 30 data be skewed?
Because in 1986 in Minnesota, the ethnic majority was scandanavian. And there are many more women in the study than men
What is leukoplakia technically?
Hyperkeratosis
Why is the gingiva/mucosa pink?
Because you are seeing the vasculature through a translucent membrane (epithelium)
When might materia alba NOT be a white lesion?
When the patient has stained it with coffee, tea, smoke, etc.
What might the lesion of a microwave burn look like?
A white center (scab/necrotic tissue) with a red halo (rubor/healing tissues)
What is the chemical name of acid? What is its pH
Acetyl salicylic Acid
pH = 2
What can you recommend to someone who overdoes it owhen using listerine?
If they feel they must use it all of the time, at least dilute it to a 50:50 mix
Besides dessication, how else might a cotton roll cause harm if left in contact with the epithelium for too long?
The cotton can take up toxins and transfer them to the epithelium
What is the most common fungal infection of the oral cavity?
Candidiasis
What oral infection used to be treated in infants with a purple dye called phenyl thaline?
Thrush (Candidiasis in infants)
What is the microbe associated with Candidiasis/Thrush?
Candida albicans
What are the two forms in which you can find C. albicans
Spore vs. Hyphae
What common treatment for Asthma can actually cause a Candidiasis infection?
Inhalers
What percent of the population has candida albicans in their mouth all the time?
1/3-1/2; but we don’t get sick because it is the spore form
What are the major predisposing factors for C. albicans infection?
Immune Status:
AIDS
Malignancy
Suppression
Medications
Abx
Steroids (e.g. Inhaler)
Partial and Complete DenturesMicroscopically, what diagnostic indicators are we looking for to confirm a C. albicans infection?
Branching hyphae
In what clinical situation will it be more likely to find red candida vs. white?
Under dentures
For this course’s purposes, what drug name would you prescribe to a patient with C. albicans?
Simply antifungal (not a pharm course)
What is the difference between a cream and an ointment? Which would be a better choice to treat candida on the dorsum of the tongue?
Cream = Water Based Ointment = Oil Based
Ointment would be better because the solution would not dissolve into the water based saliva
What common while removable lesion can show up as a white line on the buccal mucosa at about the level of the occlusal plane?
Linea alba
What causes Linea alba?
it is hyperkeratosis from chewing/friction of the cheeks
What is the treatment for Linea alba?
No treatment recommended
Considering it is present in 70-80% of the ethnic group, African Americans might say that it is abnormal not to have this white, removable lesion?
leukoedema
Describe what leukoedema looks like? What is the treatment?
Bilateral
While/Milky White Opalescence
NO TREATMENT
How would you know that a leukoedema lesion is fluid filled?
If you put tension on the lesion the fluid will run out and the mucosa will appear normal. Once the tension is released, the fluid will return
Why is nicotine stomatitis a very misleading term?
Because it is neither a lesion related to nicotine nor an inflammation of the mouth
What causes nicotine stomatitis?
The heat induced destruction of soft tissue on the palate….often seen in pipe and cigar smokers because they don’t inhale
What is the most common demographic for nicotine stomatitis/smokers palate?
Men over 45
What are the “volcano tipped” papules sometimes seen in nicotine stomatitis?
Inflammed salivary glands
What can you tell about an edentulous patient who has nicotine stomatitis on his/her palate?
That they don’t wear their dentures very often
What is the presentation of Oral Hairy Leukoplakia?
Bilaterally on the lateral borders of the tongue
What virus and condition is Oral Hairy Leukoplakia associated with?
EBV in AIDS patients
Why is Oral Hairy leukoplakia white?
Candida is growing on the ends of the hyperkeratotic folds
how does tobacco pouch keratosis present?
White lesions form where dippers keep their pouch. White is hyperkeratosis
After 20-40 years, what is the most likely form of cancer to develop out of a dipping habit?
verracous (wart like) carcinoma
What while oral lesion can be described as a chronic mucocutaneous disease?
lichen planus`(cutaneous because it’s often seen as a skin lesion).
What are the four P’s of lichen planus?
Purple
Pruritic
Polygonal
Papules
Who gets lichen planus more often, women or men?
Women 3:2
What age group most often gets lichen planus
Middle aged adults
What oral lesion is associated with striae of wickham?
Lichen planus
Why don’t we have a cure for lichen planus?
Because we don’t really know what causes it
When can lichen planus turn very painful?
When it ulcerates
What are the two classifications of ORAL lichen planus
Reticular (net-like) and Erosive
What is the most obvious differentiating factor to decide between reticular and erosive?
Painful (erosive/ulcerative) Non Painful (Reticular/Striae)
What other oral lesions must you rule out before deciding on a lichen planus diagnosis?
Lichenoid Drug Rxns
Can you (a dentist) definitively determine if it is a drug rxn or lichen planus?
No. They are identical histologically. You must work with an MD
What oral lesion is associated with saw tooth rete pegs prior to ulceration?
Lichen planus
Why is it important to watch leukoplakia very carefully for 2 weeks?
Because it could be indicative of cancer
What type of cancer is associated with leukoplakia?
Invasive SCC
What could be indicative of carcinoma in situ (in terms of leukoplakia?
Jumbled up epithelium layers
What is the abnormal cellular growth progression of leukoplakia?
Molecular change within DNA
Dysplasia
Carcinoma in Situ
Invasive SCC (Broken through basement membrane)
What is the most important factor in a leukoplakia prognosis?
How early in the progression the lesion was discovered?
If after two weeks you tell the patient to just “keep an eye on it” what are the chances leukoplakia will turn malignant?
4%
Why is leukoplakia considered a pre-malignant lesion?
Because by the time it is found, it has already reached the dysplasia stage (or worse) 25% of the time
What is the etiology of leukoplakia?
Tobacco Friction Alchohol UV Rays Microbes Sanguinaria
What part of the leukoplakia lesion should be biopsied?
The worst looking part
