Chapter 4 Dental Conditions Flashcards
Common, mild, self-limiting, virus
Affects 1/3 to 1/2 of the US population
Recurrent Herpetic simplex
Sx:
- Prodromal symptoms of fever, cervical lymphadenopathy, and malaise
- Numerous pin-head vesicles which rupture and ulcer on the perioral skin, vermilion border, and oral mucosa
- Severe and painful gingivitis with difficulty eating
Herpetic Gingivostomatitis
Treatment of herpetic gingivostomatitis
Heals in 7-14 days
Acyclovir 200-800mg five times daily for 7-14 days may speed recovery
Treat symptoms:
- Hydration
- Systemic analgesia
- Antipyretics
- Soft bland diet
Common, mild, self-limiting re-manifestation of the Herpes Simplex virus, re-activated in immunocompromised patients
Recurrent Herpes Simplex
HSV-1 remains in latent state in the trigeminal ganglion until body is compromised by:
- Sunlight
- Menstruation
- Fatigue
- Fever
- Stress
- Immunological compromise
Commonly known as “cold sore” or fever blisters”
Herpes labialis
Prodromal symptoms of pain, burning, or tingling
1-5 mm vesicles with erythematous border that ulcer and may form larger ulcers
Occurs on keratinized and non-keratinized mucosa
Intraoral herpes simplex
Treatment for intraoral herpes simplex
Heal in 7-14 days
Acyclovir
Treat symptoms:
- Analgesia
- Hydration
- Antipyretics
- Soft bland diet
May have prodrome of itching, tingling, or burning at blister sites
Primarily found on vermillion border and/or commissure of lips
Pain present for first 2 days, may be acute for 5 days
Presents as papules that become pustular and ulcerate before scabbing
Herpes labialis
Treatment for herpes labialis
Lesions heal 7-14 days
Topical/systemic antivirals at first sign of prodrome or lesion
Treat symptoms:
- Ice
- Warm cloth
- OTC creams
- NSAIDs
Common, severe, non-contagious bacterial infection of the gums with sudden onset
“trench mouth” or “Vincent’s Angina”
Brought on by opportunistic Fusobacteria and spirochetes as a result of immunosuppression, extreme stress, poor oral hygiene, malnutrition, and/or smoking.
Necrotizing Ulcerative Gingivitis (NUG)
Ulcerations on dental papillae. Punched out appearance.
Overwhelming foul breath.
Rapid onset may be accompanied by malaise or fever.
Lymphadenopathy, acute painful bleeding gingiva.
Necrotizing Ulcerative Gingivitis
Treatment for NUG
Soft toothbrush for teeth
Oral hygiene and nutrition instruction
Hourly rinses with warm saline OR twice daily rinses with hydrogen peroxide or chlorhexidine
Remove contributing factors
Treatment of NUG that does not improve after 48 hours
Antibiotic treatment:
- Penicillin
- Erythromycin
- Tetracycline
Opportunistic fungal overgrowth of the lining of the mouth
Oral Candidiasis (thrush)
Part of the normal oral flora, and is an opportunistic yeast/fungus
Candida Albicans
Fungal overgrowths occur in people who:
- Taken antibiotics/corticosteroids
- AIDS
- Leukemia
- Chemotherapy
- Xerostomia
- Endocrine Disorders
Most common manifestation of oral candidiasis
Presents as a white slough that can be easily wiped away to reveal erythematous tissue
Thrush (acute pseudomembranous candidiasis)
Thrush:
White material is made up of:
Debris, fibrin, and desquamated epithelial cells that have been invaded by yeast cells
Thrush can also develop on:
Vulva, Anus, or other body folds
Thrush:
May present on commissure of lips and cause:
Angular cheilitis
Uncommon symptoms of thrush:
Pain, may feel like burning
Dysphagia and hoarseness
Metallic, acidic, salty, or bitter taste
Treatment of thrush
Antifungal therapy
- Fluconazole
- Ketoconazole
- Clotrimazole
- Nystatin mouth rise TID
0.12% Chlorhexidine and half-strength hydrogen peroxide rinses
Clean dentures with Nystatin powder
HIV infected patients with thrush may need:
Voriconazole
“Canker Sores”
Common, unknown etiology.
Immune response associated with herpes virus 6, but not viral or communicable
Manifests after malnutrition, disease, trauma, or stress
Recurrent Aphthous Stomatitis (RAS)
Prodrome of burning or itching
1/4 to 6mm, round, yellow gray fibrinoid centers surrounded by red halos
Found on non-keratinized tissue
Painful, especially with physical contact or spicy food
RAS
Treatment of RAS
Self healing, 10-14 days
Topical corticosteroids provide symptomatic relief
Used selectively in recurrent aphthous ulcerations in HIV-positive patients
Thalidomide
Umbrella term for conditions producing dysfunction of the jaw joint or pain in the jaw and face
Often in or around the temporomandibular joint (TMJ) and other muscles of the head and neck, the fascia, or both
Temporomandibular disorders (TMD)
A person is considered to have TMD only if:
Pain or limitation of motion is severe enough to require professional care
Most TMD is related to the disturbed movement of:
- Mandibular condyle
- Glenoid fossa
- Cartilaginous articular disk
Causes of TMD
- Clenching and grinding of teeth
- Trauma
- Arthritis
- Malocclusion and missing teeth
- Abnormal growth of the condyle
TMJ immobility or fusion of the joint
Ankylosis
TMD:
Disorder of unknown etiology characterized by persistent accelerated growth of the condyle
Condylar hyperplasia
Facial deformity caused by a short mandibular ramus
Condylar hypoplasia
TMD:
Myofascial pain syndrome can be caused by:
Tension, fatigue, or spasm in the masticatory muscles
TMD:
Often results from trauma or infection, but may be congenital or a result of RA. Chronic, painless limitation of motion occurs. When ankylosis leads to arrest of condylar growth, facial asymmetry is common.
Ankylosis
Crossbite malocclusion, facial asymmetry, and sifting of the midpoint of the chin to the unaffected side. Lower border of the mandible is often convex on the affected side.
Condylar Hyperplasia
Deviation of chin to affected side, elongated mandible, flatness of face on unaffected side. Malocclusion.
Condylar Hypoplasia
Symptoms include bruxism, headaches, pain and tenderness in and around the masticatory apparatus or referred to other locations in the head and neck. Possible limitations to mobility. Placing tongue blades 2-3 thick between molars on both sides may ease symptoms when patient bites down.
Myofascial pain syndrome
Results from changing patterns of hyperkeratosis and erythema on dorsum and edges of tongue
Desquamated filiform papillae in irregular circinate pattern, often with an inflamed center and white or yellow border
2-3% of the population
Geographic Tongue
Dark, elongated filiform papillae, strained by chromogenic microorganisms, giving the appearance of hair
Hairy Tongue
Predisposing factors of hairy tongue
Xerostomia
Soft diet
Poor oral hygiene
Smoking
Certain Medications
Treatment for hairy tongue:
Good Oral hygiene including scrubbing tongue
Resolving predisposing factors
Soft nodule; if superficial, covered by thin epithelium; appears bluish, most common on the lips and floor of the mouth (ranula)
Occurs as a result of a ruptured or obstructed minor salivary gland
Mucocele
Treatment of mucocele
Some spontaneously resolve. Salt water rinses 6 times a day for several days.
May require surgical removal.
Does not resolve with incision or drainage.
Lacerations to mucosa must be repaired by an oral and maxillofacial surgeon or otorhinolaryngologist if:
Stensen’s or Wharton’s ducts are compromised
Place mucosal sutures ___mm from wound edges and ___mm apart
2-3
5-7
Nerve that supplies the upper lip
Infraorbital
Nerve that supplies the lower lip
Submandibular
