Anatomy - Week 14 PP Flashcards
Glossitis
- General term used to describe inflammation and
changes in the topography of the tongue - There is atrophy of the papilla to creating a
smooth erythematous tongue - Causes: * Allergic reactions
- Irritations from foods
- Nutritional deficiencies
Black Hairy Tongue
- The filiform papillae are so greatly elongated that
they resemble hairs - These elongated papillae become stained by food
tobacco and chromogenic bacteria, hence the
name - May be caused by an imbalance of oral flora after the administration of antibiotics or the use of
mouthrinses
Fissured Tongue
- Fissured tongue is a variant of normal; its cause is unknown
- Theories about its cause include vitamin deficiency and chronic trauma over a long period
- The dorsal surface (top) of the tongue is marked
by having deep fissures or grooves, which become
irritated if food debris collects in them - Patient with a fissured tongue is advised to brush
the tongue gently with a soft toothbrush to keep
the fissures clean of debris and irritants - variation of normal, not to be worried about HOWEVER extra care is required..
Bifid Tongue
- Rare
-Partial fusion of the tounge during development - no treatment required
- split of tongue into 2
Ankyloglossia
- Tongue tie
- The lingual frenum is attached near the tip of the tongue
- The short lingual frenum can also attached the tip
of the tongue to the floor of the mouth - Limits movement of the tongue
◦ Speech disruption - Treatment ◦ Frenectomy (surgical removal of part of the lingual frenum)
Clinical Considerations
The Oral Mucosa is a good indicator of health or
disease
* Many diseases or conditions manifest in some way on oral tissue
* The dental team plays an important role in early
detection of these diseases
Pernicious Anemia
- A condition in which the body does not absorb vitamin B12
- People with this condition show signs of anemia, weakness, pallor, and fatigue on exertion
- Other signs include nausea, diarrhea, abdominal pain, and loss of appetite
- Oral manifestations of pernicious anemia include angular cheilitis (ulceration and redness at the corners of the lips), mucosal ulceration, loss of papillae on the tongue, and a painful burning sensation of the tongue
HIV and AIDS
Oral lesions are prominent features of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection
* Oral lesions develop because of the breakdown of the immune system that occurs when the T-helper cells become depleted as a result of the disease
Acquired Immunodeficiency Syndrome
- Because the patient’s immune system is severely damaged, death is usually caused by an
opportunistic infection - Opportunistic infection: One that normally would be controlled by the immune system but cannot be controlled because the immune system is not
functioning properly - Some of the lesions that look like HIV- and AIDS related infection may also be caused by other
disorders
HIV Gingivitis
- There is often a bright red line along the border of the free gingival margin
- Also known as atypical gingivitis(ATYP) * In some cases, there may be progression of the
bright red line from the free gingival margin over the attached gingival and alveolar mucosa
HIV Periodontitis
- Resembles acute necrotizing ulcerative gingivitis superimposed on rapidly progressive periodontitis
- Other symptoms include:
◦ Interproximal necrosis and cratering
◦ Marked swelling
◦ Intense erythema over the free and attached gingiva
◦ Intense pain
◦ Spontaneous bleeding and bad breath
Candidiasis
Candidiasis is often the initial oral sign of progression from HIV-positive status to AIDS
* In a patient with a compromised immune system, candidiasis can be a very debilitating and serious disorder
Cervical Lymphadenopathy
Enlargement of the cervical (neck) nodes
-Lymphadenopathy is frequently seen in association with AIDS
Lymphoma
- Lymphoma is the general term used to describe malignant disorders of the lymphoid tissue
- In the immunocompromised individual, it may occur as a solitary lump or nodule, a swelling, or a nonhealing ulcer that occurs anywhere in the oral cavity
- The swelling may be ulcerated or may be covered with intact, normal-appearing mucosa
- Usually painful, the lesion grows rapidly and may be the first evidence of lymphoma
Hairy Leukoplakia
- Can be an imporant early manifestation of AIDS
-* A filamentous white plaque usually found
unilaterally or bilaterally on the lateral borders
(sides) on the anterior portion of the tongue - May spread to cover the entire dorsal surface of
the tongue - Can also appear on the buccal mucosa, where it
generally has a flat appearance
Kaposi Sarcoma = HIV POSITIVE
- One of the opportunistic infections that occurs in patients with HIV infection
- Lesions may appear as multiple bluish, blackish, or reddish blotches that are usually flat in the early stages
- Kaposi sarcoma is one of the intraoral lesions that is used to diagnose AIDS
- can be intra or extra oral
Herpes Simplex
- Herpes simplex lesions usually occur on the lip
- In immunocompromised patients, the lesions may occur throughout the mouth
- An ulcer caused by the herpes virus that persists for longer than 1 month may be an indicator of AIDS
- Patients who do not have HIV or AIDs may also suffer from herpes
Human Papillomavirus
Human papillomavirus appears most commonly in immunocompromised individuals * Diagnosis is made on the basis of history, clinical
appearance, and biopsy findings
* Lesions are a common finding in patients with early HIV infection
* These warts appear spiky, and some have a raised, cauliflower-like appearance
Oral Cancer
One of the 10 most frequent cancers in the world
* The incidence, as well as the site, of the cancer varies greatly from country to country
* Most oral cancers do not cause pain in the early stages, and the thorough dentist is most likely to be the first to detect them
* These cancers are fatal if not detected early enough or if left untreated
- cell proliferating abnormally, when multiple cells are mutated
Oral Cancer - Canada Stats
- According to the Canadian Cancer Society (2024a): ◦ It is estimated that in 2024: 8,100 Canadians will be diagnosed with head and neck cancer.
2,100 Canadians will die from head and neck cancer. 5,800 men will be diagnosed with head and neck cancer and 1,550 will die from it.
2,300 women will be diagnosed with head and neck cancer and 590 will die from it.
What is Cancer?
-Cells in the mouth sometimes change and no longer grow or behave normally
- these changes may lead to non-cancerous (benign) tumours such as warts and fibromas
- Changes to cells of the mouth can also cause precancerous conditions.
- This means that the abnormal cells are not yet cancer, but there is a chance that they may become cancer if they aren’t treated.
- The most common precancerous conditions of the mouth are leukoplakia (white) and erythroplakia (red)
Erythroplakia
- Erythroplakia is a flat or slightly raised, red area
that often bleeds easily if it is scraped. - Erythroleukoplakia is a patch with both red and
white areas
Squamous Cell Carcinoma
- In some cases, changes to the cells of the mouth
can cause oral cancer. * The oral mucosa is made up of squamous cells
called the squamous epithelium. * Most often, oral cancer starts in these flat, thin
squamous cells. * This type of cancer is called squamous cell
carcinoma of the mouth
Carcinoma means..
Malignant neoplasm (growth) of the epithelium (tissue lining the mouth)
Adenocarcinoma
Malignant tumor that arises from the submucous glands underlying the oral mucoasa
Sarcoma means..
Malignant neoplasm arising from supportive and connective tissue
Osteosarcoma means..
Malignant tumor involving the bone
- the mouth, the affected bones are the bones of the jaws
Leukemia
- A cancer of the blood-forming organs
- Characterized by rapid growth of immature white blood cells
- Oral symptoms of leukemia may be some of the first indications of the disease
- Symptoms in the gingival tissues include hemorrhage, ulceration, enlargement, spongy
texture, and magenta coloration of the gingiva - Enlargement of lymph nodes, symptoms of anemia, and general bleeding tendencies are typical
Rare Types of Oral Cancer
- Salivary gland cancer
- Melanoma
- Bone and soft tissue carcinoma
- Lymphoma
Metastasize
- Cancer spreads to other regions of the body
-Oral Cancer - usually spreads to the neck and cervical lymph nodes
Appearance of Early Cancer
*White areas
* Red areas
* Ulcers
* Masses - lumps or bumps
* Pigmentation
Warning Signs for Oral cancer..
- Early stages – not painful
- Sore that does not heal
- Any lump or swelling on the neck, lips, or oral cavity
- White or rough textured lesions on the lips or oral cavity
- Numbness in or around the oral cavity
- Dryness in the mouth for no reason
- Burning sensation or soreness for no reason
- Repeated bleeding in a specific area for no reason
- Difficulty speaking, chewing or swallowing
Etiology of Cancer
- Exact etiology unknown
- Changes (mutations) to the DNA within cells - can cause the cell to stop its normal function and may allow a cell to become cancerous.
Risk Factors of Oral Cancer
- Tobacco and alcohol use.
◦ Most cases of oral cancer are linked to cigarette smoking,
heavy alcohol use, or the use of both tobacco and alcohol together.
◦ Using tobacco plus alcohol poses a much greater risk than using either substance alone * Betel nut chewing and areca nut - HPV ◦ Infection with the sexually transmitted human papillomavirus (specifically HPV 16 and 18) has been linked to a subset of oral cancers.
- Previous cancer
- Family history of squamous cell carcinoma
- Sun exposure. ◦ Cancer of the lip can be caused by sun exposure.
- Diet and nutrition ◦ A diet low in fruits and vegetables may play a role in oral cancer development
- Weakened immune system
- Graft-versus- host disease
- Lichen Planus - white web like structure
- Poor oral health
- Inherited conditions
◦ Fanconi amenia
◦ Dyskeratosis congenital
Smokeless Tobacco
- Chewing tobacco or snuff presents a serious health hazard
- It is a major concern because of the high rates of precancerous leukoplakia and oral cancer among users of smokeless tobacco
- Cancers of the pharynx, larynx, and esophagus occur 400 to 500 times more frequently in users of smokeless tobacco
- Also linked to an increased incidence of tooth loss
from periodontal disease
Possible Risk Factors of Oral Cancer
- Poor fitting dentures
- Drinking very hot beverages
Unknown Risk Factors of Oral Cancer
- using alcohol-based mouthwash
- smoking cannabis (marijuana)
- infection with human immunodeficiency virus (HIV) or having acquired immunodeficiency syndrome (AIDS)
Vaping and Oral Cancer
- The long-term effects of vaping on general and oral health are not yet known.
- Current evidence suggests that vaping is a gateway to conventional cigarette smoking and may increase the risk of heart damage and stroke in similar ways to cigarette smoking
- Vaping has also been linked to cases of acute lung disease, some of which have been fatal
- The specific risks of vaping liquids containing nicotine or cannabis on oral health are unknown but may be similar to that of tobacco products
Cannabis & Oral Cancer
- Cannabis smoking can result in periodontal complications, xerostomia (dry mouth),
leukoplakias as well as increased risk of oral cancers. - Cannabis contains many of the same carcinogens as tobacco.
- Cannabis is often smoked in combination with tobacco, which complicates attributing causality of resulting disease
Detection of Cancer
- Complete head and neck exam
- Imaging
◦ X-rays (panorex) ◦ Chest x-ray
◦ Computed tomography (CT or CAT Scan) ◦ Magnetic resonance imaging (MRI) ◦ PET Scan
◦ Ultrasound - Panendoscopy
Detection of Oral Cancer
- Biopsy
◦ Incisional biopsy - slice of lesion
◦ Excisional biopsy
◦ Punch biopsy - punch a piece of skin out
◦ Fine needle aspiration - test fluid inside of lump, extract the solution
◦ Exfoliative cytology - scrape the lesion - Lab tests of biopsy samples
- HPV 16 testing
- Toluidine blue staining ◦ uses a dye to check for abnormal areas in the oral cavity
- Tissue Fluorescence Visualization ◦ uses a special light to find abnormal cells in the oral cavity
◦ Velscope
Treatment
- Surgery
- Radiation therapy
◦ Affects salivary glands, blood vessels and bones of the jaw
◦ Patients who receive this type of treatment may develop dental problems
Xerostomia
Radiation mucositis - Chemotherapy
- Combination of all three
Dental Implications of Radiation Therapy
- Xerostomia
◦ Lack of adequate saliva and the reduced blood supply can cause oral infections, delay healing, and make it very difficult to wear dentures - Radiation caries
◦ Caused by the lack of saliva, radiation caries usually appears first in the cervical areas of the teeth
◦ The teeth also may become extremely sensitive to hot and cold stimuli - Osteoradionecrosis
◦ Bone may be subject to necrosis (death) after radiation
treatment
Dental Implications of Chemotherapy
Chemotherapeutic agents are powerful drugs that destroy or deactivate rapidly dividing cancer cells
* Significant adverse effects of these drugs frequently involve the oral tissues
◦ Mucositis
◦ Aphthous ulcers
◦ Transient reactions
◦ Xerostomia
◦ Delayed healing
◦ Dental malformation
Oropharyngeal Cancer
-Emerging Threat..
*Rates of head and neck cancers are increasing and are set to continue growing
-An increased number are caused by the human papillomavirus (HPV)
HPV
-human papillomavirus (HPV) is a DNA virus that belongs to the papilomaviridae family
-frequently sextually transmitted, causing infections which hace an incubation period varying from three weeks to an inderminate length of time
-HPV is spread through initmate skin to skin contact
* Oral HPV is transmitted to the mouth by oral sex
* Most people clear the HPV virus in one to two year
* Can persist in some people, causing cancer in the oropharynx area
* HPV is thought to cause 60-70% or oropharyngeal cancers in the US
Type of HPV..
- More than 100 types of HPV
- Only a few are high risk for oral cancer ◦ Primarily HPV-16 and HPV- 18 (over 90% of HPV positive oral cancers are HPV 16 positive) ◦ HPV-6 and, 11 are related to veneral warts and present ithe oral cavity as condyloma acuminatum
Condyloma Acuminatum
- Clusters of multiple, pink, slightly papillary nodules attached with a broad base
- Painless, persistent
- Common in young adults
Symptoms of HPV-Related Head and
Neck Cancers
- A sore, or soreness or irritation that doesn’t go away
- Red or white patches, or pain, tenderness, or numbness in mouth or lips
- Lumps, thickening tissues, rough spots, crusty or eroded areas
- Difficulty chewing, swallowing, speaking or moving your jaw or tongue
- A change in the way your teeth fit together when you close your mouth
Preventing HPV infection
- Limited sexual partners
- Using condoms/dental dams
- Pap tests
- Vaccinations
Lowering risk of Oropharyngeal Cancer
- Alcohol and tobacco products may contribute to
oropharyngeal cancers
