clinical considerations Flashcards
what are papillae
specialised epithelia found on the tongue
what are the different forms of oral ulcerations
infections
neoplasms
trauma
infectious causes of ulcerations
bacterial
deep fungal
viral
neoplasmic causes of oral ulcerations
squamous cell carcinoma
lymphoma
malignant salivary gland tumours
traumatic causes of oral ulcerations
biting
contact with sharp cusps
thermal burns
chemical burns
what is squamous cell carcinoma
cancer occuring on sun exposed skin that can occur in the mouth
describe pancreatic cancer
this can affect the exocrine or endocrine portion of the pancreas and surgical treatment can be ineffective
describe cystic fibrosis
caused by chloride channel protein genetic defect and affects the exocrine portion of the pancreas
what are the oral implications of diabetes mellitus
periodontitis
dry mouth
susceptibility to infections
what are disorders of the endocrine system
reduced hormone release
excessive hormone release
hormone resistance
what causes scurvy
lack of vitamin C
oral implications of scurvy
loose teeth
skin haemorrhages
death
what is systemic lupus erythematosis
an autoimmune disease in which auto antibodies target host tissues
what are examples of host tissues affected by lupus
skin
bones
tendons
kidneys
what are the oral implications of lupus
dryness, soreness, buccal and palatal lesions
what is sjogrens
an autoimmune disease caused by autoantibodies affecting glands that produce the tears and saliva.
symtoms of sjogrens disease
- dry eyes and mouth
- dental caries
- candidiasis
what can cause sjogrens to develop
it can develop independently or it can be caused by other disorders like lupus or arthritis
what is the resolution used for light microscopy
0.2 micrometers
what is is the resolution for electron microscopy
one nanometer
how many times greater is electron microscopy compared to light microscopy
200
what does the periodic acid schiff stain
mucins, brush borders and basement membranes as they are PAS positive and will stain magenta
what are ulcerations
a break in the epithelium
what is herpatic stomatitis
pale vesicles and ulcers visible on the palate and gingivae, especially anteriroly, and the gingivae impacted are erythematous and swollen. infectious
what is an example of a non infectious ulceration
large traumatic ulcers which have minimal inflammation and a white patch formed by keratin
what causes squamous cell carcinoma
dysplastic epithelial cells proliferating in an uncontrolled manner, destroying and invading adjacent tissue
the ulcers are classically having a rolled border and a central nectrosis
describe histological viewing of squamous cell carcinoma
the epithelium invades deeply into the connective tissue and underlying muscle
what are autoimmune disease
reactions to self antigens
what can antihistamines do
cause drowsiness and dry mouth
oral implications of corticosteroid inhalers
oropharyngeal thrush and chronic candidosis
what are systemtic corticosteroids used for
asthma
name the features of rheumatoid arthritis that are important for dentistry
- associated with sjogrens disease
- aspirin can lead to bleeding and anaemia
- antimalarials can lead to oral and skin pigmentation
- pencillamine can lead to taste loss
- methotrexate can lead to poor healing, oral ulcers and folate deficiency
in which salivary gland is salivary calculi most common
submandibular gland - 80% of the calculi occur here
what forms salivary calculi
accretion of calcium salts and round organic nidus
do salivary calculi cause dry mouth
no
what is a stricture
narrowing of a duct in the body
where do salivary gland strictures commonly occur and why
in the parotid papilla in the buccal mucosa due to chronic trauma from projecting denture claps, faulty restorations, sharp edges on broken teeth leading to fibrosis
what causes salivary duct strictures
fibrosis
what are mucoceleles
cavities filled with mucous that can occur in minor salivary glands - saliva can leak into the surrounding tissues to excite an inflammatory reaction, forming a rounded collection of fluid
what are mucous retention cysts
dilation of salivary ducts due to obstruction
in which glands are mucous retention most common
the parotid and minor glands
what causes mumps
paramyxovirus
what does mumps cause
swelling of the parotids and other exocrine glands. highly infectious and is the most common cause of acute parotid swelling. leads to headahces and fever
what is sialadenitis
swelling of the salivary glands
is mumps infectious
yes
how does mumps spread
by saliva
what can confirm the diagnosis of mumps
a rise in the titre of IgG antibodies in those who are not vaccinated
what does bacterial parotitis mean
pain in one or both parotid glands, leads to leaking from the parotid papilla on the buccal mucosa.
seen in those who are dehydrated after surgery, due to xerostomia, sjogrens disease etc
what are the bacterial causes of bacterial parotitis
staphyloccocus aureus, streptococci, oral anaerobes
what are the organic causes of xerostomia
- sjogrens disease
- irradiation
- mumps
- HIV infection
- hep c
- sarcoidosis
- amyloidosis
- iron deposition
what are the functional causes of xerostomia
- dehydration from haemorrhage, fluid deprevation or loss
- drugs
- anxiety
- depression
which drugs cause xerostomia
diuretic overdose
atropine
ipratropium
hyoscine
some antidepressents
antihistamines
decongestants
bronchodilators
appetite suppressants like amphetamines
what do patients with xerostomia typically complain of
- unpleasant taste
- difficulty eating and swallowing
what is the most effective analgesic agent
2% lidocaine with adrenaline
what is the chief cause of sudden death under anaesthesia
cardiovascular disease
who is at risk of developing endocarditis
patients with congenital anomalies such as valve or septal defects, and those with prosthetic valves
what are the non cardiac risk factors for developing infective endocarditis
age
diabetes
poor oral hygience
prior kindey disease
what proportion of infective endocarditis cases result from oral organisms
30-40%
what clears bacteria from the blood
phagocytic cells lining the sinusoids in the liver or spleen, and circulating leukocytes
how does infective endocarditis occur
damaged valves are infected by bacteria passing through the lumen of large vessels, causing bacteria to come into contact with the endothelium
they adhere to the valve using fibronectin and other carbohydrate receptors and bind to platelets and fibrin on the damaged surface
platelets and fibrin deposit over them
lumpy vegetations of bacteria and fibrin form on the free edges of the valves, which are progressively destroyed by inflammation and immune response against bacteria - this renders the valves incompetent
how can bacteria enter the blood
from tissue infections, during surgery and from peripherally inserted central catheters (PICC lines)
what are the main sources of oral bacteria causing bacteraemia
the gingival crevice and periodontal pockets. large numbers of bacteria are in close contact with inflammed tissues containing dilated, thin walled blood vessels. chance of bacteria entering the vessels is increased by the movement of teeth during mastication
what is acute endocarditis linked to
staphyloccocus aureus
fungi
what is subacute infective endocarditis linked to
bacteraemias of oral organisms - viridans streptococci
which valve is most commonly impacted by infective endocarditis
the mitral valve
what can infective endocarditis do to the rest of the body
the valve vegetations can shed small foreign bodies called emboli into systemic circulation which can cause distant effects like splinter haemorrhages and damage to various organs
what is used to prevent and treat infective endocarditis
antiobiotic prophylaxis which kills any bacteria before entering the circulation so they do not have the opportunity to adhere to the heart valves
what is systemic lupus eyrthematous
this is when antibodies are against DNA and its associated proteins, and there are usually genetic predispositions affecting the genes involved in non specific immune mechanisms
describe how systemic lupus erythematous manifests
circulating autoantibodiy antigen complexes lodge in small vessels where they activate neutrophils and macrophages to damage the tissue
how can lupus affect the mouth
it can cause stomatitis and sjogrens syndrome if it affects the mouth
oral lichen planus like lesions (white, lacy patches)
the lower lip vermillion border can become malignant, and bleeding tendencies.
non steroidal anti inflammatory drugs can lead to bleeding, anaemia and lichenoid reactions
what can systemic sclerosis look like
raynauds and joint pain
the skin thins and becomes stiff and pigmented
facial features become smoothed out and mask like
opening of the mouth can become limited
what is sarcoidosis
collection of inflammatory cells - granulomas are small and round with occasional small multinucleate cells
what can cause cervical lymphadenopathy
apical abscesses, cellulitis, periodontitis and pericoronitis
what is syphilis
enlarged, soft and rubbery cervical lymph nodes
what is cervical lympadenopathy
swelling of the lymph nodes in the neck
what is a common cause of the symptoms of heart burn
gastrooesphageal reflux and consequent oesophagitis
what causes barrett’s oesophagus
persistent gastrooesophageal reflux leading to the oesophageal lining undergoing metaplasia to become a more gastric mucosa
what causes gastrooesophageal reflux
smoking
excessive alcohol consumption
obesity
overlarge meals
what is coeliac disease
inflammation of the ileal mucosa, loss of villi, leading to malabsorption
what are the dental implications of coeliac disease
glossitis, recurrent aphthae
what does glossitis mean
inflammation and pain in the tongue
what is aphthae
ulcers
what can happen to the enamal in coeliac disease
hyperplasia - hypoplastic mottling, localised, opacities, and discolouration
why is enamel hyperplasia common in coeliac disease
malabsorption
what is crohns disease
inflammatory bowel disease causing thickening and ulceration of the ileocaecal junction
what are the oral effects of crohns
none direct although the anaemia caused by crohns can lead to ulcers and candidosis
orofacial features of crohns disease
- diffuse soft or tense swelling of the lips and mucosal thickening
- gingivae may be erythmatous and swollen
- mucosal tags in the sulcuses
- glossitis
why does malabsorption lead to glossitis
iron, folate and vitamin 12 deficiency
what are orofacial granulomatosis
oral mucosal granulomatous inflammation without an identifiable cause
which sites of the mouth are most commonly involved in orofacial granulomatosis
lip and buccal mucosa
what does diagnosis of orofacial granulomatosis require
biopsy
which conditions can lead to malabsorption
- coeliac disease
- crohns
- resection of the stomach or ileum
- pancreatic insufficiency
- liver disease due to failure of bile secretion into the gut
what is ulcerative colitis
inflammatory disease of the large intestine causing ulceration and fibrosis
symptoms of ulcerative colitis
blood and mucous in the stools
what is the impact of anaemia on the mouth
- prolonged bleeding
- mucosal lesions
- oral infections
- anaesthetic complications
- glossitis
- angular stomatitis
- recurrent aphthae
- candidosis
- lowered resistance to infection
what is angular stomatitis
red and swollen area around the mouth caused by candida infection or by staphylococcus aureus
what are polyps
fleshy growths forming on the lining of the colon or rectum
what is gardners syndrome
polyposis of the colon and osteomas on the jaw
what are osteomas
bone tumours that usually form on the skull
what is pseudomembranous colitis
a complication of prolonged antibiotic therapy that results in the passage of blood and mucous in the stools and sometimes fragments of necrotic bowel mucosa
what are the three main causes of liver failure
- idiopathic cirrhosis
- alcoholic cirrhosis
- hepatitis
what is idiopathic cirrhosis
spontaneous i think
how is hep a acquired
contaminated food or water, incubation period of 2-6 weeks
mild jaundice
long term complications are rare
how is hep e transmitted
faecal oral route
how is hep b transmitted
spread at birth, through sexual contact or through infected blood
how does the hepatitis virus replicate
within hepatocytes
how does hepatits infection cause cirrhosis
it replicates in the hepatocytes, so the immune response to the virus eventualy clears the infection damaging the liver in the process
why is hep c more relevant in dentistry than hep b
it has no vaccination, and its impacts are more severe and frequently fatal.
how does hep b get transmitted
via blood through needle sharing, needle stick injuries and tattooing
which proportion of patients diagnosed with hepatitis C progress to chronic hepatitis
85%
what does chronic hepatitis eventually lead to
cirrhosis and liver failure
is hep c transmitted in dentistry
rarely
what does riboflavin deficiency lead to in dentistry
glossitis and angular stomatitis
what does nicotinamide deficiency lead to
glossitis, stomatitis, and gingivitis
what does vitamin B12 deficiency lead to
pernicious anaemi
glossitis
aphthae
what does folic acid deficiency lead to
glossitis
aphthae
what does vitamin C deficiency lead to
scurvy, gingival swelling, bleeding
what does vitamin D deficiency lead to
rickets and hypocalcification of the teeth
what does vitamin A deficiency lead to
night blindedness
what is pellagra
nicotinamide deficiency
what does nicotinamide deficiency do to the tongue
the tip and lateral regions become red and swollen, the dorsum becomes covered by a heavily infecte greyish fur
when is folid acid deficiency often observed
during pregnancy
why are pregnant women advised to take supplements of folic acid
reduce the risk of neural tube defects
what causes gigantism
overproduction of growth hormone by the anterior pituitary during skeletal growth causes overgrowth of the skeleton and soft tissues
what causes acromegaly
this is caused by excessive growth hormone release in middle age, and increases the growth of the hands and feet. the mandible becomes enlarged and protrusive, and the whole jaw is lengthened, and the angle becomes more oblique. vocal cord thickens and the voice becomes deeper. the nose, lips, tongue and ears are bigger
what is goitre
diffuse thyroid enlargement
what is graves disease
autoimmune thyroiditis caused by stimulatory autoantibodies
what is cretinism
deficient thyroid activity from birth can lead to this, and results in short stature, intellectual impairment, overlarge tongue, dry skin, dull facial expression, sensitivity to cold and bradycardia
can cretinism be treated
yes but it must be done in early life to allow for normal physical and mental development
what are the symptoms of adult hypothyroidism
weight gain
fatigue
dry skin and hair loss
intolerance to cold
what is the dental management for patients with a deficient thryoid
avoid diazepam and opioid analgesics
what is a lingual thyroid
when there is a failure of the embryonic thyroid anlage to descend into the neck, the patients thyroid gland will lie somewhere around the dorsum of the tongue
can a lingual thyroid be removed
only in the instance where there is a confirmed thyroid gland in the neck, identified through ultrasound scanning
what are the dental implications of hyperthyroidism
dentine may not be completely mineralised, and the roots of the teeth may be short
what is addisons disease
adrenocortical hypofunction, which is usually an autoimmune disease with organ specific circulating autoantibodies
why may patients crave salt if they have addisons disease
due to the lack of production of aldosterone
symptoms of addisons found
salt craving
loss of weight
low blood pressure
susceptibility to hypotensive crises
abnormal oral pigmentation
why can abnormal oral pigmentation be observed in patients who have addisions disease
due to the adrenocorticotropic hormone secretion as the peptide hormone has a similar amino acid sequence to melanocyte stimulating hormone
what is cushings disease
adrenocorticotropic hypofunction caused by a pituitary adenoma
symptoms of cushings disease
headaches
hypertension
oesteoporosis
obesity of the trunk and the face
what is the trunk of the body
the central part of the body
how can dentists manage diabetic patients
- time treatment so as not to disturb routine insulin administration
- local anaesthesia (adrenaline has no significant impact on blood sugar)
- deal with diabetic complications
- if using general anaesthesia, special precautions must be taken
what are the oral effects of pregnancy
aggravated gingivities
hypersensitive gag reflex
iron or folate deficiency
what are the impacts of renal failure on the oral cavity
mucosal pallor
xerostomia
mucosal ulcerations
thrush
bacterial plaque
