Chapter 16: Oral Cavity and Salivary Glands Flashcards
What is the difference between Dental Caries, Dental Plaque, and Gingivitis?
DC: enamel/dentin demineralization by bacteria acidic metabolites (most common cause of tooth loss < 35)
- Viridians Group Strep (Strep Mutans)
DP: sticky biofilm on teeth, can cause gingivitis
- not removed = TARTAR (calculus)
G: soft tissue inflammation of mucosa/soft tissue around teeth (mainly seen in adolescence)
- from plaque buildup BELOW gum line
- bacteria release acids that can cause dental caries
What is Periodontitis?
What pt. population is it commonly seen in and how does the bacteria differ from normal oral bacteria?
- inflammation of periodontal ligmanent, alveolar bone, cementum (due to POOR ORAL HYGIENE)
- presents normally without associated disorders, but can be systemic = endocarditis, brain/lung abscesses
- DOWN’S SYNDROME and Leukemia
- bacteria in normal gingiva normal facultative Gram (+), but plaque causing periodontitis has aerobic Gram (-) bacteria in it
What are 3 bacterial microbes associated with Periodontitis? (AA/PG/PI)
Actinobacillus actinomycetemcomitans
Porphyromonas ginginvalis
Prevotella intermedia
What are Aphthous Ulcers (Canker Sores)?
What do they look like and who do they affect?
- common, exceedingly painful superficial muscosal ulcerations of unknown etiology
- single ulceration w/erythematous halo around yellowish fibronopurulent membrane
- usually seen in pts < 20 and resolve within 7-10 days (Familial predilection)
What is the difference between:
- Irritation Fibroma
- Pyrogenic Granuloma
- Peripheral Ossifying Fibroma
- traumatic fibroma due to repetitive trauma
- submucosal nodular mass on buccal mucosa
- along bite line or gingiva
- pregnancy tumor; inflammatory lesion
- ulcerated, red/purple, erythematous
- can develop into peripheral ossifying fibroma
- from long-standing pyrogenic granuloma or from periodontal ligament cells
- red, ulcerated, nodular gingiva lesions
- peaks with young, teenage females
What is a Tori?
- bony protrusions/outgrowths of palate (NO cartilage)
- generally asymptomatic and more common in females
- Torus Palatinus and Torus Mandibularis
Oral Herpes Simplex Virus
Who does it usually infect, what are two symptoms it can cause (AHG/RHS), and how can it be diagnosed (2)?
- HSV-1 infection of children 2-4 yo
Acute Herpetic Gingivostomatitis
- diffuse oral vesicles with ulceration
Recurrent Herpetic Stomatitis
- reactivation in mucosa with same ganglion
- Herpes Labialis (small vesicles groups on mouth)
Diagnosed: Unck Test and TZANK SMEAR
- (+) for HSV, glassy, multinucleated
- trigeminal/semilunar ganglion
What is the most common oral fungal infection, what does it look like, and who does it commonly affect (3)?
Oral Candidiasis (Thrush = pseudomembranous) - Candida Albicans
- pseudohypae with budding yeast on SILVER STAIN; superficial gray-white inflammatory membrane that CAN be SCRAPED OFF (erythematous base)
- pts. on antibiotics, diabetics, and immunodeficient
- vaginal yeast infection –> predispose kids (PAS (+))
What other fungi (2) can infect the oral cavity/head and neck? What do they cause?
Aspergillus Fumigatus - 45 branching hypae w/septae
Rhinocerebral Mucormycosis - no septae, irreg. branch
- both like to invade surrounding vessels and cause necrotic lesions in the oral cavity (FUNGAL EMBOLIS)
What are the oral manifestations of:
- Scarlet Fever
- Measles
- Infectious Mono
- Diphtheria
- Phenytoin (Dilantin) ingestion
- Stevens-Johnson Syndrome
- fiery red tongue (raspberry tongue) with white coating
- from Group A Strep. pyrogens
- ulcerations above Stensen (parotid duct) = Koplik Spot
- cough, coryza, conjunctivitis
- gray-white exudative membrane w/palatal petechiae
- Monospot Test (+) –> EBV
- dirty white, tough membrane over tonsils/pharynx
- corynebacterium diphtheriae
- fibrous enlargement of gingivae (hyperplasia)
- seizures + dilantin use
- Type IV hypersensitivity; widespread “target” lesions
Hairy Leukoplakia
Where is it located in the oral cavity and what does it look like?
- oral lesions on lateral tongue border in immunocompromised pts. (HIV/EBV)
- fluffy, confluent patches of hyperkeratotic thickening (CANNOT BE SCRAPED OFF vs Candida)
- “balloon cells” in upper spinous layer (EBV infected)
- candida can be superimposed (hairier)
What are Osler-Weber Rendu Disease and Peutz-Jeghers Syndrome?
OWR: hereditary hemorrhagic telangiectasia
- rare AD –> BVs
- recurrent epistaxis that can lead to whole GI bleeds
PJS: polyps and dark colored spots on palms/feet
- also ORAL mucosa (inc. risk of certain cancers)
What is a Keratocystic Odontogenic Tumor?
- cyst w/keratinized stratified squamous epithelium and prominent basal layer common in 10-40 yo MALES
- usually in POSTERIOR MANDIBLE
- associated with Gorlin Syndrome and tumor suppressor mutation PTCH on 9q22
differentiate from other odontogenic cysts because of AGGRESSIVE NATURE
What is the difference between Leukoplakia and Erythroplakia?
BOTH ARE PREMALIGNANT LESIONS for SCC
L: white patch/plaque of oral cavity that CANNOT be scraped off that cannot be characterized as other disease
- BIOPSY –> assume precancerous until proven not
E: red, velvety eroded area of oral cavity with intense subepithelial inflammatory rxns (SEVERE DYSPLASIA)
- greater risk for malignant transformation
Oral Squamous Cell Carcinoma
What are 3 major risk factors, where does it commonly occur, and what is the difference between Moderate and Severe Dysplasia?
RF: HPV, Tobacco/Alcohol, and Betel Quid/PAAN
- on ventral tongue, mouth floor, lower lip, soft palate (LOOK UNDER DENTURES)
- raised, firm, pearly plaques that ulcerate
Moderate: dysplasia halfway below histology
Severe: dysplasia ABOVE halfway histology
What is the difference between HPV and Classical Oral Squamous Cell Carcinoma?
HPV - HPV16/18 at tonsils, base of tongue, oropharynx
- white, nonsmoking males 35-55 yo
- p16 overexpression (E6 - p53/TERT & E7 - RB/p21)
- greater long-term survival (brown basal layer stain)
Classical - TP53, P63, and NOTCH1 gene mutations
- associated with ALCOHOL and SMOKING
- mainly in oral cavity
- associated with pre-malignant lesions
What is Field Cancerization?
- multiple primary tumors develop independently in upper aerodigestive tract due to years of chronic exposure of mucosa to carcinogens
- secondary primary tumors are most common cause of death
What is Xerostomia?
- dry mouth due to lack of salivary gland secretion
- most-commonly drug related but also associated with Sjogren’s Syndrome
- causes “Burning Mouth Syndrome” (hyperactive PNS), tongue fissures, dryness, and inc. risk of oral infections
What is Sialadenitis?
What are 4 causes of it?
- inflammation of the oral glands
- caused by: autoimmune (Sjogrens), viral (mumps- PAROTID gland), bacteria, Trauma (Mucocele or Ranula)
What is Mumps and what is a serious complication of it?
What is Mumps caused by?
desquamation of involved cells in salivary glands = edema/inflammation leading to salivary gland pain/swelling
- can spread to other sites and can cause ASEPTIC MENINGITIS
- caused by PAROMYXOVIRUS
Mucocele vs Ranula
M: most common salivary gland lesion
- on lower lip (trauma) with blue translucent hue
- cyst with granulation tissue w/mucin or MOs
- NO EPITHELIAL LINING
R: mucocele of SUBLINGUAL gland
- EPITHELIAL LINING on cyst
- connect the two bellies of the mylohyoid muscle
Nonspecific Sialadenitis
What is it, which gland does it commonly involve, and what two bacteria are normal causes?
- painful salivary gland enlargement with purulent discharge following obstruction by stones or food debris (SIALOTHIASIS)
- usually involves SUBMANDIBULAR GLAND
- bacteria: S. aureus and S. viridans
usually involves UNILATERAL single gland
What are two benign (P/W) and malignant (M/A) neoplasms of the salivary gland?
Benign:
- Pleomorphic Adenoma
- Warthin Tumor
Malignant:
- Mucoepidermoid Carcinoma
- Adenoid Cystic Carcinoma
the smaller the salivary gland, the more likely the neoplasm is to be malignant
Pleomorphic Adenoma
What is it, what does it look like, and what are two risk factors associated with it? (IR/P)
What cancer can it lead to?
- BENIGN tumor mixture of epithelial and myoepithelial cells (MIXED TUMOR) commonly found in Parotid > Submandibular; more common in FEMALES
- epithelial nests in matrix of myxoid, hyaline, chondroid, osseous differentiation (rounded, well demarcated, encapsulated)
RF: ionizing radiation, PLAG1 overexpression
can become Carcinoma ex Pleomorphic Adenoma (most aggressive of all malignant neoplasms
