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
