1/29: Intraoral Exam II Flashcards
1
Q
What is xerostomia a side effect of?
A
Numerous over the counter and prescription medications
2
Q
What can xerostomia be a symptom or sign of?
A
Systemic disorder or disease
3
Q
What can xerostomia be a response to?
A
Physical climate, or a manifestation of an emotional response
4
Q
Who is at a greater risk for developing a dry mouth condition?
A
Elderly patients, but the problem is not limited to any specific age group
5
Q
What does xerostomia increase your risk for?
A
Caries, erosion, dentinal hypersenstivity, and candidiasis
6
Q
Most cases of xerostomia are _______
A
Chronic
7
Q
What are med history of xerostomia?
A
- diabetes
- hormone changes (menopause, pregnancy)
- depression, anxiety medications
- radiation for head and neck cancer
- autoimmune disorder (Sjogren’s syndrome)
8
Q
What is a subjective evaluation of xerostomia?
A
- Do you have difficulty swallowing?
- Does your mouth feel dry when eating?
- Do you sip liquids to help swallowing?
- Do you have any oral burning or soreness?
- Do you often have bad breath?
- Do you eat crushed ice or drink fluids to keep your mouth moist?
9
Q
What is a clinical assessment of xerostomia?
A
- Reddened, pebbled surface of tongue
- dry and cracked corners of the mouth
- red, glossy, parched mucosal tissues
10
Q
What is the test for xerostomia?
A
- Mirror “stick” test: place mirror against the buccal mucosa and tongue
- Saliva pooling: check for saliva collection in the floor of the mouth
11
Q
What should you evaluate in a patient with xerostomia?
A
Flow and consistency
- tissues well moistened?
- sore mucosa
- burning sensation in the mouth
12
Q
What are xerostomia symptoms?
A
- candidiasis
- angular chelitis
- burning tongue
- root and cerivcal caries
- stomatitis
13
Q
What is stomatitis?
A
Inflammation of the mucous membranes of the mouth
14
Q
What is candidiasis?
A
- white plaque
- creamy white lesions
- looks like hyperkeratosis (BUT RUBS OFF)
15
Q
Where is candidiasis located?
A
Buccal mucosa
Lateral borders of the tongue
16
Q
What is another name for candidiasis?
A
Thrush
17
Q
Where can candidiasis spread to?
A
Tongue
Hard and soft palate
Tonsillar region
18
Q
What are candidiasis risk factors?
A
Immunocompromised
Pregnancy
Poor oral hygiene
Smoking
Stress
Depression
19
Q
What are candidiasis risk factors?
A
Birth control pills
Long term AB
Diabetes
Dentures that don’t fit
Xerostomia
Iton, B12 deficiency
20
Q
What is Acute Pseudomembranous?
A
MOST COMMON TYPE OF CANDIDIDIS
Creamy white patches
Easily wipe off leaving an erythematous base
21
Q
What do you get pain with in Acute Pseudomembranous?
A
Spicy/acidic foods
Dysphagia
22
Q
Where is Acute Pseudomembranous located?
A
Tongue, buccal mucosa, floor
23
Q
What does Acute Pseudomembranous look like?
A
White plaque
Hyperkeratosis (but rubs off)
24
Q
Where is Acute Pseudomembranous located?
A
Inside the corners, buccal mucosa, lateral tongue
25
What is the relation between atrophic candidiasis and dentures?
It can be located under dentures, usually ill-fitting or dentures are never taken out of mouth
26
What does atrophic candidiasis look like?
Red on palate or tongue
27
What does atrophic candidiasis burn due to?
With spicy foods and alcohol
28
What is treatment of candidiasis?
Oral hygiene
Yogurt, acidophilus
Avoid alcohol, simple sugars
29
What is the most common candidiasis?
Acute Pseudomembranous
30
What are medications that treat candidiasis?
Antifungals
- nystatin (rinse and tablets)
- ketaconozole (can cause severe liver damage)
31
What kind of herpes is seen mainly in children?
Primary herpes gingivostomatitis
32
What is primary herpes gingivostomatitis caused by?
HSV1 in most cases
33
Severe primary infections of herpes simplex have?
Oral lesions accompanied by high fever, malaise, cervical lymphadenopathy and dehydration
34
In less comon-primary infection of herpes what is this due to?
HSV1 or HSV2
35
What is herpes gingivostomatitis?
Vesicles develop in the oral cavity, including the pharynx, palate, buccal mucosa, lips and/or tongue
36
What do vesicles break down into in herpes gingivostomatitis?
Small ulcers and are covered with an exudate
37
Where do lesions extend into in herpes gingivostomatitis?
Lips and buccal mucosa
38
When do lesions resolve without therapy in herpes gingivostomatitis?
Without therapy in two weeks
39
Where does HSV not survive long in?
External environment
40
Almost all primary infections of herpes gingivostomatitis occur from contact with?
An infected person who is releasing the virus
41
What ages does herpes gingivostomatitis start?
<10 from adults
42
What is herpes gingivostomatitis caused by?
Contagious
Kissing, etc
43
What are the two types of herpes gingivostomatitis?
type 1 = mouth, lips, face
type 2 = genital
44
Where is the location of herpes gingivostomatitis?
Outer lips and attached gingiva
45
What are two common things that manifest as herpes simplex?
Fever blisters and cold sores
46
What are prodromal signs of herpes simplex?
- Tingling, itching, pain, burning that arise 6-24 hours before lesions develop
- Multiple fluid-filled blisters
- Merge and collapse
- Yellowish crust
- 2 weeks healing
47
What is herpes simplex considered?
Virus
48
Where is herpes simplex dormant?
In nerve cells
49
When does herpes recur?
With immune weakness
- stress
- fever
- illness
- injury
- sunburn
50
What is herpetic whitlow?
Infections of the thumbs or fingers
Grouped, fluid or pus filled
Usually itch and or painful
51
In the past, how was primary herpetic gingivostomatitis treated?
Symptomatically, but if the infection is diagnosed early, antiviral medications can have a significant influence
52
What is medication as treatment for herpetic gingivostomatitis?
Acyclovir suspension-initiated during the first 3 symptomatic days in a rinse and swallow technique 5x/day for 5 days
Significant acceleration in clinical resolution is seen
Development of new lesions ceases
53
In which phase is recurrent herpes labialis best treated?
Prodrome phase
54
What kind of ointment/cream decreases the number of vesicles in herpes labialis?
Acyclovir, but clinically minimal reduction in healing and pain
55
What are 3 medications for herpes labialis?
Systemic acyclovir
Valacyclovir
Famciclovir
56
For patients whos herpes labialis recurrences appear associated with dental procedures, what is their regiment?
2g of valacyclovir taken 2x on the day of procedure and 1g taken 2x the following day
57
What happens to patients that are on medication for herpes labialis but are immunocompromised?
The viral load tends to be high, and replication is not suppressed completely by antiviral therapy
58
What are aphthous ulcer also known as?
Canker sores
59
What age do aphthous ulcers (canker sores) start and what is their prevalence and frequency?
60% of the US pop
10-20 years old
Frequency varies
60
When does prodromal tingling or burning sesnation begin in aphthous ulcers (canker sores)?
1-2 days before the ulcer appears
61
What is the duration of aphthous ulcers (canker sores)?
3 days pain, 7 days healed
62
What is treatment if aphthous ulcers (canker sores) is mild?
Topical corticosteroids
63
Although no single triggering agent is responsible, the mucosal destruction of aphthous lesions represents?
A t-cell mediated immunologic reaction
64
Aphthous lesions tends to occur along?
Family lines. When both parents have a history of aphthous ulcers, there is a 90% chance that their children will develop the lesions
65
What are the three clinical variations of aphthous lesions?
Minor
Major
Herpetiform
66
Patients experience fewest recurrences and shortest duration in what?
Minor aphthous ulcerations
67
Where do Minor aphthous ulcerations arise?
Almost exclusively on nonkeratinized mucosa
68
What are minor aphthous ulcerations preceded by?
An erythematous macule in association with prodromal symptoms of burning, itching, or stinging
69
What is the size of minor aphthous ulcerations?
Measure between 3-10mm in diameter, oval, and heal without scatting in 7-14 days
70
How many lesions cause out of proportion pain for minor aphthous ulcerations?
1-5 lesions for the size of ulceration
71
What mucosa is most frequently affected by minor aphthous ulcerations?
Buccal and labial mucosa followed by the ventral surface of the tongue
72
What is recurrence rate of minor aphthous ulcerations?
Highly variable, ranging from one ulceration every few years to two episodes per month
73
What is the size of major aphthous ulcerations?
Larger than minor aphthae- usually 1-3cm
74
What kind of aphthous ulcerations have the longest duration per episode?
major aphthous ulcerations
75
What are the size of major aphthous ulcerations?
Deeper and can take 2-6 weeks to heal
76
What can major aphthous ulcerations lesions cause?
Scarring
77
When is the onset of major aphthous ulcerations?
After puberty
78
What is the greatest number of lesions and most frequent recurrence?
Herpetiform aphthous ulcerations
79
What are the size of Herpetiform aphthous ulcerations?
Small 1-3mm with as many as 100 ulcers present in a single recurrence
80
What do Herpetiform aphthous ulcerations have resemblence to and why?
Because of their small size and large number, the lesions bear a superficial resemblance to a primary HSV infection
81
In Herpetiform aphthous ulcerations, it's common for individual lesions to ______ into ___________ ulcerations
coalesce; larger irregular
82
What is the healing time of Herpetiform aphthous ulcerations?
7-10 days, but the recurrences tend to be closely spaced
83
Many patients are affected almost constantly for period as long as _______ due to Herpetiform aphthous ulcerations
3 years
84
What mucosa is involved in Herpetiform aphthous ulcerations?
Any mucosa
85
What is the gender predominance and onset age of Herpetiform aphthous ulcerations?
Female; adulthood
86
What are the size of minor canker sores (aphthous ulcers)?
<1 cm and shallow
87
What are the size of major canker sores (aphthous ulcers)?
>1 cm and deeper
88
What kind of minor canker sores (aphthous ulcers) scar when heal?
Major aphthous ulcers
89
What kind of canker sores or aphthous ulcers are more numerous and vesicular?
Herpetiform
90
What are symptomatic treatments for aphthous ulcers?
1. Viscous benzocaine
2. Orajel, anbesol
91
What are local anti-inflammatory treatment for aphthous ulcers?
Kenalog in orabase paste 2-4x/day
92
What is an example of a sesaling agent as a treatment for aphthous ulcers?
Amesal, etc
93
What is the only FDA approved tx for canker sores (aphthous ulcers)?
Aphthasol
paste = barrier
apply 2-4x/day
(must start early (prodroamal stage))
