Ch. 16 Robbins GI Path Flashcards
What are dental carries?
Most common diseases world wide
- tooth loss before age 35
Colonization of teeth by bacteria (s. mutans) due to poor hygiene and high sugar diet
What are associated complications with dental carries
Pain
Weight loss/Nutrition deficits
Life threatening infections
What is dental plaque?
a sticky, colorless, biofilm that collects between and on the surface of teeth
What is periodontitis?
an inflammatory process that affects the supporting structures of the teeth (periodontal ligaments) alveolar bone, and cementum
Are gingivitis and periodontitis reversible?
yes!
What is the difference between inflammatory and reactive lesions?
Inflammatory has assaulting agent (ie bacteria) that causes local reaction
Reactive - response to stimulus and injurious stimuli (ie chemicals, hypoxia, drugs)
Describe aphthous ulcers and who the afflict
common. recurrent. exceedingly painful superficial ulcer of oral mucosa without know etiology
occur in people less than 20
resolve spontaneously in 7-10 days
Where do most traumatic fibrous proliferations occur?
Buccal mucosa from repeated trauma ie chewing on cheek.
Well circumscribed (benign) and easily removed surgically.
what is a pyogenic granuloma?
Inflammatory lesion typically found on the gingiva of children, young adults, and pregnant women
Why is pyogenic granuloma a misnomer?
on histology it is very vascular and lobular
NOTHING pyogenic or granulomatous about it
Describe a peripheral ossifying fibroma
Hard, red, ulcerated, and/or nodular lesion on gingiva
young teenage females
What layer must be removed during the excision of a peripheral ossifying fibroma?
periosteum - otherwise will reoccur
Describe tori palatini (torus palatinus)
a bony lesion on the roof of the mouth. Painless and often asymptomatic
Which subtype of HSV causes orofacial lesions
HSV-1
When do primary infections of HSV occur in most people?
2-4 y/o
herpetic stomatitis
What test can you run for HSV to confirm the presence of a herpes infection
Tzank test, however positive for all herpes? ie herpes zoster
What is the most common fungal infection of the oral cavity and the most frequent cause of human fungal infections?
Candidiasis
What factors influence clinical candidiasis infection?
the strain of C. albicans
composition of individual oral flora
immune status of the patient
Deficiency in which types of cells might predispose a patient to Candida
Neutrophils
macrophages
Th17
What is the major difference between candidiasis and leukoplakia
you can scrape off candidiasis
you prepare a wet mount slide of an exudate from your patient and see pseudohyphae, budding yeast, what organism are you looking at?
candida
What disease is associated with hairy leukoplakia?
EBV
What is the oral change associated with scarlet fever?
Strawberry tongue - white coated tongue with hyperemic papillae
Raspberry tongue - fiery red tongue with prominent papillae
What is the oral change associated with measles?
spotty enanthma precedes skin rash - koplik spots
what is the oral change associated with infectious mononucleosis
acute pharyngitis and tonsillitis, grey-white exudative membrane, palatal petichiae
What is the oral change associated with diphtheria
characteristics dirty white, fibrinosupurrative, tough, inflammatory membrane over the tonsils
What is the oral presentation of myeloid neoplasms?
ie AML
tumors with monocytic differentiation often infiltrate the skin (leukemia cutis) and the gingiva
a patient presents with gingival hyperplasia, they have decent hygiene and you see a med in their hx. what medication are they on?
Dilantin (Phenytoin)
Describe Osler-Weber-Rendu (Hereditary Hemorrhagic Telangiectasia)
a rare AD disorder that affects blood vessels throughout the body (causes vascular dysplasia) and results in tendency for bleeding
Why must the multicellular keratocystic odontogenic tumor be differentiated from other odontogenic tumors?
due to the aggressive nature of the neoplasm
occur mostly in males within the posterior mandible
what type of carcinomas make up 95% of all head and neck cancers
Squamous Cell Carcinoma
An old curmudgeon sits on his porch with a shotgun after the second american civil war in November of 2020. The porch isnt covered and he puffs tobacco from a pipe waiting for someone to fuck around and find out. what cancer is he predisposing himself too
SCC/Cancer of the lower Lip
Which variants of HPV are highly responsible for oral and pharyngeal squamous cell carcinomas
HPV 16 a lot
HPV 18 also
Who is most at risk for oropharyngeal squamous cell carcinoma?
White, non smoking males age 35-55
….so dylan
Which two viral genes of HPV inactivate which cellular pathways
E6 P53
E7 RB
If a patient has HPV pos SCC, do they have a better or worse long term survival?
greater
If a white, male, non-smoking patient presents with fatigue, weight loss, painful swallowing, and a lump on his neck what is your top DX
HPV SCC
acquired and mutations involved in classic oral SCC target which genes
p53
Notch1
p63
Where does classic oral SCC present?
ventral tongue floor of mouth lower lip Soft Palate Gingiva
Is erythroplakia or leukoplakia more omonous
erythroplakia - almost always associated with carcinoma in situ
If the early stage survival for classic SCC is 80% why is it so dangerous
many neoplasms are associated with other primary tumors that are missed and many lesions are asymptomatic until late stage where 5 yr survival is 20%
which gland produces salivary amylase?
parotid gland
which gland produces lingual lipase?
submucosal layer of the tongue
what is xerostomia?
dry mouth
incidence higher in pts over 70.
presence of xerostomia in burning mouth syndrome suggests what other possible pathology?
hypofunctioning PNS
which group of people are most prone to mucoceles
toddlers, the elderly, and tanner on a table at Leinenkugel’s. Basically any one with a predisposition to falling
what is the treatment of mucocele
complete excision
What autoimmune disorder is known for having dry mouth
Sjogren syndrome
how common are salivary gland neoplasms
not very common at all
What is the relationship between size of gland and likelihood of a neoplasm to become malignant?
inverse
bigger gland -> less likely malignant
What is a pleomorphic adenoma/mixed tumor?
divergent differentiation of a single neoplastic clone
well demarcated mass
can become malignant (aggressive)
PLAG1 rearrangements
Which malignancy of the mouth and face area has a male predominance, it is exclusively parotid, and smokers are at an 8X greater risk?
Warthin Tumor
AKA Papillary Cystadenoma Lymphomatosum
What is the most common primary malignancy of the salivary glands
Mucoepidermoid Carcinoma (15% of all salivary tumors)
60-70% in parotid but also minor glands
What is the chromosomal translocation in Mucoepidermoid carcinoma
11:19(q21;p13) balanced translocation producing MECT1-MAML2
What is dangerous about adenoid cystic carcinoma?
50% in minor glands (poor prognosis)
unpredictable - 50% disseminate before primary tumor removal
What is gingivitis?
Inflammation of the oral mucosa (gums)
