Dental Block 1 Flashcards
What is the vermillion border a junction between?
What type of cells is it made of?
Skin and Mucous membranes
Stratified squamous
What type of glands are located in the vermillion border?
Fordyce Granules- Ectopic sebaceous glands at corners of the mouth and cheeks opposite molar teeth
What are the characteristics of the Masicatory Mucosa
25%, Gingiva covering hard palate, primary mucosa in contact w/ food during chewing,
Keratinized
What are the characteristics of the Lining Mucosa
60%, floor of mouth, ventral tongue, and tissues of soft palate with no function during mastication,
Non-keratinized
What are the characteristics of Specialized Mucosa?
15%, covers dorsal tongue
Non/cornified papillae
How does the Lamina Propria differ between the Lining and Masticatory Mucoasa?
Lining- NKSS loose CT w/ collagen, contains glands
Masticatory- P/KSS, variable lamina propria, para/kartinized strat squamous
Gingiva belongs to what category of mucosa?
What are the 3 parts of the gingiva?
Masticatory
Attached, Interdental, Free (includes sulcus)
Characteristics of Attached Gingiva
Keratinized, stippled, separated from aveolar mucosa by mucogingival groove, attached to tooth by junction of epithelium
Characteristics of Marginal/Free Gingiva
Keratinized, not stippled, bound on inner margin by gingival sulcus (separate from tooth), bound to outer margin by oral cavity and apically by free gingival groove
How does gingiva attach to teeth?
Attach on neck of tooth by junctional epithelium
What type of muscle makes the tongue?
What divides it into halves?
What are the three parts and two surfaces of the tongue?
Striated
Median septum
Parts: oral, pharyngeal, root
Surface: dorsal, ventral
What is the most important articulator for speech production?
What is a second function of the tongue?
Tongue
Taste
Where are bitter, sour, salty and sweet tastes located on the anterior 2/3s of the tongue?
Bitter- posterior surface
Sour- inner middle
Salty- peripheral except tip
Sweet- tip
What are the four types of papillae on the tongue?
Filiform- anterior 2/3, fine hair-like
Fungiform- anterior 2/3, round red spots
Circumvallate- V shaped row near posterior
Foliate- posterior lateral border of the tongue
There are no taste buds on the posterior 1/3 of tongue, but what is located there?
What is the most numerous type of papillae?
Nodular surface due to lingual tonsils
Filliform, lack any taste buds
What CN innervates the general/taste sensations of the anterior 2/3 of tongue?
Sensation- lingual nerve, CN5 general sensory
Taste- chorda tympani, CN7 special sensory
What CN innervates the general/taste sensations of the posterior 1/3 of tongue?
Glossopharyngeal nerve- CN9, general and special
What CN innervates the generals sensation at the base of the tongue?
Internal laryngeal nerve- CN10
What types of muscle fibers make up the intrinsic tongue muscles and what is their function?
Longitudinal, Transverse, Vertical
Alter shape of tongue
What are the four extrinsic muscles of the tongue?
What is their function?
Palatoglossus, Genioglossus, Hypoglossus, Styloglossus
Tongue movement, connect tongue to surrounding structures: soft palate/bones (mandible, hyoid, styloid)
What are the functions of the extrinsic muscles?
Tongue movement
Connect tongue to surrounding structures: soft palate and bones (mandible, hyoid, styloid)
What muscle is responsible for tongue protrusion?
What muscle is responsible for tongue retraction?
What muscle is responsible for tongue depression?
What muscle is responsible for tongue elevation?
Genioglossus
Styloglossus
Hyoglossus and Genioglossus
Styloglossus and Palatoglossus
What nerve innervates the intrinsic nerves?
What nerve innervates the extrinsic muscles?
Hypoglossal
Hypoglossal EXCEPT the palatoglossus muscle- supplied by CN10
What artery and vein supply the tongue/mouth?
Artery: Dorsal lingual artery
Vein: Lingual Vein- drains to internal jugular
What lymph nodes are on the tip of the neck?
What lymph nodes are on the anterior 2/3 of the neck?
What lymph nodes are the posterior 1/3 of the neck?
Submental bilateral, Deep cervical
Submandibular unilateral, Deep cervical
Deep cervical
Characteristics of the Parotid Gland
Largest
Serous saliva w/ ptyalin- starches
30% of saliva
Characteristics of Submandibular gland
Bi-lobed, excretes through submandibular duct
10% mucous, 90% serous
60% of saliva produced w/ salivary amylase
“Gleeks”
What are the characteristics of the sublingual gland?
Smallest
Mostly mucous
Mulitple ducts of Rivinus (8-20)
Only 5% of total saliva produced
Where are minor salivary glands located in the mouth?
Between 600-1000 that line oral cavity and oropharynx secreting serous, mucous or mixed saliva directly into oral cavity
What are the functions of PNS CNs 3 7 9 and 10
3- narrow pupil, focuses lens
7- tears, nasal, salivary glands
9- parotid gland
10- viscera down to proximal half of colon, cardiac, pulmonary, esophageal plexus
What are the two parts of the roof of the oral cavity?
Hard Palate: bony, anterior
Soft Palate: muscular, posterior
What structures does the hard palate help make?
Roof of oral/floor of nasal cavities
Ant: Maxilla palantine process
Post: Palatine plates
Bound by alveolar arches
What is the under surface of the hard palate covered with?
What structure does it show in the anterior parts of the mouth?
Mucoperiosteum Transverse ridges (rugae)
What is the function of the masseter muscle?
Where does the Masseter muscle span from and to?
Elevate mandible, crush/grind chewing
Zygomatic arch to mandible angle
What happens to hypertrophy or bruxism occurs in the masseter muscle?
Bruxism- hypertrophy, which leads to reduced/occluded parotid gland
What is the function of the temporalis muscle?
Where does the Temporalis muscle span from and to?
Largest muscle that elevates/retracts mandible
Exerts light chewing forces
Temporal fossa to body of mandible
What is the function of the Medial Pterygoid muscle?
Where does the Medial Pterygoid muscle span from and to?
Elevate, protrusion and lateral shift of the mandible
Sphenoid bone to medial surface of mandibular ramus
What is the function of the Lateral Pterygoid muscle?
Where does the Lateral Pterygoid muscle span from and to?
Protrusion/retrusion/depression of mandible
Pterygoid plate/Sphenoid bone to articular disc
What event occurs if the lateral pterygoid muscle premature contracts prematurely?
What two muscles make up the “mandibular hammock” of the face?
TMJ shifting
Masseter
Medial Pterygoid
Term dentition is used to describe ?
Natural teeth in jaw bones
Primary, mixed, permanent
All four muscles of mastication are innervated by what CN?
5-3
The first set of 20 primary teeth are AKA what 3 names?
Baby teeth
Milk teeth
Deciduous teeth
Define/when does Mixed Dentition occur?
Permanent dentition refers to what?
When both primary and permanent teeth are present between 6-12y/o
32 secondary/adult teeth
How are the mouth quadrants broken up by the World Dental Federation?
UR- 1-8 MRQ
UL- 2-8 MLQ
LL- 3-8 ManLQ
LR- 4-8 ManLQ
Define Mesial
Define Distal
Towards midline of dental arch
Away from midline of dental arch
What are the 3 basic food processing functions of teeth?
What are the four basic types of teeth?
Cut, Hold/grasp, Grind
Incisor, Canine, Premolar, Molar
Function of incisors
Function of canines
Function of premolars (bicuspis)
Function of molars
Cut w/out heavy force
Cut and tear w/ force
Hold and grind food
Chew and grind food
How do premolar and molars differ in number from baby to adult teeth?
Pre-molar: none in primary, two in permanent
Molar: two sets in primary, three sets in permanent
Define Eruption
Define Exfoliation
Movement of tooth from developmental position to occlusion plane
Process of roots of primary teeth are reabsorbed so primary too falls out
Define Occlusion
Occlusal contact is the trigger that stops ?
Mandibular/maxillary relationship at closing
Tooth eruption
What are the 3 phases of tooth eruption?
Pre-eruptive phase
Eruptive- root formation, penetration, movement, occlusion
Post eruptive
What is the second layer to begin forming in tooth anatomy?
Enamel
Begins 6-8wks in utero
How does in utero tooth formation occur?
Ameloblasts lay collagenous matrix which is mineralized by alkaline phosphatase
Enamel proteins are removed leaving mineralized tissue behind
Enamel has what type of structure?
What is the make up?
Rod/crystaline
97%- hydroxyapatite
3%- other
What is the middle layer of the tooth?
Dentin- equal hardness to bone
First layer to form, grows inward towards pulp
How is dentin formed during tooth formation?
Where does the dentin receive nutrients from?
Odontoblastic for growth/repair
Pulp
What is the make up of dentin?
70% hydroxyapatite
20% organic
10% water
What is the last tissue to form during tooth development?
Development of cementum results in ?
Cementum
Tooth eruption
Where does the cementum receive it’s nutrients since it’s an avascular structure?
What is the composition of cementum?
Periodontal ligament
50% hydroxyapatite, 50% organic and water
What does pulp comprise of?
Fibroblasts Odontoblasts Vascular/nerve/lymph components Type 1 and 2 collagen Unmineralized
Where does pulp exit the tooth?
What joins cementum of tooth to the alveolar bone?
Apex
CT Type 1 Collagen
What are the 4 functions of the periodontal ligament?
Supportive, Remodel, Sensory, Nutrition
Define BioFilm
Group of microbes that adhere to surfaces
Frequently embedded under self produced matrix of extracellular polymeric substances
Define Pellicle
Acellular layer of salivary proteins, mucins and macromolecules on oral surfaces that is 10micrometers thick
How does enamel pellicle stick and adhere to tooth surfaces?
Mucus component
What are the four functions of the dental pellicle?
Protect
Lube
Prevent desiccation
Substrate for bacterial attachment
Enamel pellicle forms how fast?
Less than 30m after brushing
What type of bacteria initially attach to sticky surfaces of pellicle?
Planktonic
How is a firm anchor established between bacteria and surfaces?
Covalent ionic/H bond mediated by organisms and receptors on surface
What is the essential first step in biofilm development?
What is the only non-shedding surface in the body?
Attachment to tooth surface
Enamel
Bacteria have what two structures that aid in surface attachment?
Fimbriae
Fibrils
What are the four phases of plaque formation?
Pellicle formation
Attachement
Young Supragingival plaque- gram pos cocci
Aged Supragingival plaque- gram neg anaerobic bacteria
What are the “early” colonizers of biofilm attachment?
Where do secondary colonizers emerge from?
Non-mutan streptococci and Actinomyces spcs.
Gingival crevice
Tongue
Saliva
What microbes are the Secondary Colonizers?
P. Intermedia P. Ioescheii Capnocytophaga Fusobacterium nucleatum Prophyromonas gingivalis
What process is essential for ongoing development of plaque’s microenvironment?
Quorom sensing
Supragingival plaque is mostly what type of microbes?
Subgingival plaque is mostly what type of microbes?
Gram positive facultative anaerobes
Mixed facultative strict anaerobe bacteria that are
Asacchorolytic- metabolizes peptides
What three processes/excretions result in decreased oxygen as tooth plaque matures?
Strep and Actinomyces are Sacchorolytic and Acidogenic and secrete a Polymeric substance causing decreased O tension
What does the Latin word Carie mean?
Rot, decay
Similar to Greek word for death
Define Caries
Infectious transmissible disease from oral bacteria that metabolize sugars into acids causing tooth demineralization
What two bacteria are the main cariogenic bacteria?
Streptococci
Lactobacillus
In order for cavities to form, what three requirements must exist?
Cariogenic bacteria
Sugar
Tooth surface
How do dental caries first appear?
Chalky white spot due to loss of translucency of enamel rods due to demineralization
What is the main microbe of the pathogenesis of caries?
Mutans Streptococcus
Actinomyces and Lactobacillus
Define Vertical Transmission
S. mutans transmitted from caregiver to infant through saliva
Most carious lesions occur where on teeth?
Interproximal surface of primary teeth
Four processes that reduce caries on teeth
Often brushing
Fresh produce
Flossing
Parents have good habits
How does saliva help prevent caries?
pH 6-8
IgA, lysozyme, lactoferrin, histatins, peroxidase
Supersaturated Ca, PO4, and BiCarb (addition of Flouride, not natural occurence)
What can cause xerstomia?
Systemic diseases
Gland damage
Surgery/radiation
Medications
Intermediate restorative material is made up of ?
Zinc oxide
Eugenol
Reqs mechanical retention and can remain for one eyar
Healthy gingiva are absent of four things and have four characteristics present?
Absent of inflammation or deformity of: Marginal Attached Alveolar Periodontium (bone, cementum and PDL)
Have: uniform color, knife edge, scalloped, firm and stippled
Gingivitis is AKA?
It is indicative of ?
Early gum disease
Precursor to advanced gum disease if inflammation extends into alveolar process, PDL and/or cementum
What is the etiology of gingivitis?
Bacterial biofilm- plaque
What are the four types of gingivits?
Plaque associated gingivitis
NUG
Medication induced
Allergic
Characteristics of plaque-associated gingivitis?
Pathogenic bacteria on salivary pellicle from poor hygiene causing inflammation
Gram pos/neg an/aerobes
Etiology- plaque and calculus
Characteristics of NUG
Stress and smoking leading to blunted/punch out interproximal papillae with a gray pseudomembrane, bad breath and pain
Can arise from immunosuppressed or nutrition
How is NUG treated?
Chlorhexidine
ABX- metronidazole
How does medication induced gingivitis present?
Gingival hyperplasia and excess collagen, caused by Cyclosporine, Phenytoin or Nifedipine
Allergic gingivitis is caused by ? but commonly by ?
How is it treated
Herbs, mouth wash, mints, gum, peppers
Cinnamon or lauryl sulfate
Topical steroids
What are four systemic causes of gingivitis?
Hormones
Drugs
Stress
Vitamin C deficiency
What are four local factors that can cause gingivitis?
Crowded teeth
Dental caries
Frenulum attachments
Overhanging restorations
What is the name of the tooth brushing technique?
Bass Sulcular Toothbrush Technique at 45* angle twice a day for 2 min each
Floss daily
Scrape tongue
Rinse w/ mouth wash
Define Gingivitis, what it includes, it’s etiology and if it’s reversible
Inflamed soft tissue
Epithelial and CTs
Poor hygiene, injury or immunocompromised
Is reversible
Define Periodontitis, what it includes, it’s etiology and if it’s reversible
Inflamed hard and soft tissue
Including alveolar bone, gingiva, and PDL from anaerobic bacteria
Define inflamed PDL, what it includes, it’s etiology and if it’s reversible
Excessive wear, mobility and widened PDL
Non-bacterial causes: poor restoration, ill fitting appliances/trauma
Bacterial- near apex due to inflammation in pulp
Reversible
What is the number cause of tooth loss in adults?
What is this cause always preceded by?
Periodontal disease
Always by gingivitis
Periodontal Dz is inflammation of what supporting structures?
Inflammation of peridontium and it’s structures:
Gingiva
PDL attachment
Aveolar bone
What are the three diseased states of periodontal diseases?
Gingiva- red/receded
PDL- loose, wide, deep
Alveolar bone- resorbs
No Tx
How will diseased tissue present with probing?
Apical migration of junctional epithelium from Cementum Enamel Junction
Loss of PDL attachment from cementum
Untreated gingivitis can advance to periodontitis creating what three issues?
Chronic inflammation
Deep pockets
Bone loss
Periodontal diseases cause deteriorating bone as a result of ?
Calculus and bacterial toxins
Classification of Gingival Periodontal Disease
Erythema/edema
Attachment at CEJ
No bone loss
Classification of Slight Periodontitis
Erythema/edema
Loss of attachment and mild reduction of bone HEIGHT
Restored w/ nonsurgical cleaning by hygienist
Classification of moderate periodontal disease
Erythema/edema
Moderate bone LOSS
Furcation invasion
Tooth mobility
Classification of Severe Periodontal disease
Severe bone loss Furcation invasion Migration of teeth Loss of occlusal vertical dimension Dentures needed
What are the early warning signs of future periodontal disease?
Gingivitis Probing apical to CEJ X-ray evidence of bone loss Tooth mobility Migration of teeth
What are S/Sx of an active periodontal disease?
Mobile teeth Mouth sores/purulence Bone loss Halitosis Blunted interproximal papillae
Define Red Bacterial Complex
Tannerella forsythia
Treponema denticola
Porphyromonas gingivalis
Define Pophyromonas gingivalis
Non motile gran neg anaerobic rod that releases enzymes/collagenases to initiate inflammation
What is the keystone pathogen for periodontal disease process?
Prphyromonas gingivalis
Chiefly responsible for bone loss
Characteristics of Tannerella Forsythia
Gram Neg Obl Anaerobe Spindle pleomorph that forms biofilm and surface layer protein adnhesion to epitherlial cells
Produces cysteine proteases and subverts host immune system
Characteristics of Treponema denticola
Gram Neg anaerobe motile spirochete that travels in viscous environment
Produces enzymes to degrade collagen and invade tissue
Unable to synthesize fatty acids, found in periocornitis sites and NUG
Treponema denticola is one of how m an types of treponems found in the oral cavity?
57
What are the non-surgical treatment methods of periodontal disease?
Sub/supra-gingival scaling and root planing every 3mon
ABX into sulcus
Rest, diet, exercise
No smoking/remove occlusion
What are the surgical innervations of treating periodontal disease?
For pockets >5mm
2-6mon after non-surgical methods
Irreversible
What are the three phases of treating periodontal diseases?
Assessment- PA/medic
Initial Dx- GenDen
Treatment- periodontist/hygienist
How does a periapical abcess appear on x-ray and what is the treatment?
Localized preiapical radiolucency with widened PDL
Treated w/ local anesthesia, I&D, refer to dentist for root canal therapy
Define Periodontal Abscess
Acute inflammation in sulcus of a periodontal pocket from pre-existing periodontal lesion with a vital tooth.
Presents as pain, edema that involves bone/PDL attachment, mobile tooth, pus and foul taste
How does a periodontal abscess appear on radiographs and how is it treated?
Bone loss from previous periodontal pocket
Local anesthetic, I&D, saline rinse, refer to dentist for scaling/root planning every 3mon
Define Pericornitis
Acute inflammation in tissues surrounding crown of partially erupted tooth from trapped food/bacteria beneath flap
How will a periconitis PT present?
Throbbing pain to ear/throat/floor of mouth
Foul taste
Trismus- facial edema
NUG like necrosis
How does a pericornitis appear on x-ray and how is it treated?
Impacted/erupted mandibular 3rd molar
Antiseptic lavage to remove debris, ABX, refer to dentist for removal of flap or extraction
Define Alveolar Osteitis
Dry Socket- post extraction inflammation of exposed alveolar process due to loss of initial blood clot due to negative pressure, suction, smoking, trauma or bacteria
How does Dry Socket present
3-4 days post extraction
Exposed unprotected bone w/ severe pain and foul odor
How are dry sockets treated?
Remove sutures and irrigate with warm saline, place Peridex antimicrobial rinse for PT home irrigation, analgesics x 1wk.
If paste is used, replace x 24hrs
What type of facial trauma causes more visible scars?
How are they sutured?
Perpendicular lacerations or normal lines of expression
Two layer closure- absorbable on inner muscle first, close skin second
Suture at vermillion border first
What type of tissue injury is treated first in facial trauma?
Hard tissues
What vascular structure needs to be noted and avoided in facial trauma?
Labial artery
What are the three classes of sutures?
Collagen
Synthetic absorbable
Non-absorbable
How are suture sizes referenced?
What size is usually used?
Diameter of suture strand denoted by zeroes.
More zeroes= smaller the strand diameter
4.0 absorbable for mouth use
What size suture material is used for different closures?
Lips- start at vermillion border Muscle- 3 or 4 Subcutaneous- 4 or 5 Epithelium- 6 nylon non-absorbable Avoid silk to skin, causes acute inflammation and scarring
Define Un/Complicated Crown Fracture
Uncomplicated- partial fracture of tip of tooth, still intact
Complicated- separation of crown from tooth body
How are teeth that are traumatically removed from the mouth stored?
Saliva, under tongue
Lowfat milk
Coconut water
Pedialyte
No water/gatorade
Don’t wrap in tiddue
Don’t leave exposed to air
Traumatically removed teeth need to be replaced within what time frame or what ?
Within 1 hr to reduce ankylosis or root resorption
Why do you not scrub root surface of a tooth avulsion?
Injures PDL cells and cementum will not attach to alveolar bone
Define Lefort Fractures 1-3
1: Transverse maxillary, above level of teeth
2: Pyramidal, level of nasal bones
3: craniofacial dysfunction, orbital level
What is the most common midfacial fracture?
What is the most common facial fracture?
Zygomatic complex from lateral blow to cheek, can depress the cheek bone (dimple)
Nasal bone
What kind of optical s/sx can be seen in an orbital fracture?
Bleeding into cornea of Fx side
Restricted movement
Fx to orbital rim risk interfering with which CN?
CN2
Define Blow Out Fx
Orbital rim remains intact but crack forms in thin bone in floor of socket (double vision, lowered globe, restricted movement, enophthalmos)
Unilateral condylar fractures lead to deviation to what side?
Affected side when mouth is open
Define Angle Class 1
Define Angle Class 2
Define Angle Class 3
Masiobuccal cusp of maxillary 1st molar aligns w/ buccal groove of Mandibular 1st molar
Masiobuccal cusp of maxillary 1st molar is anterior to buccal groove of Mandibular 1st molar
Masiobuccal cusp of maxillary 1st molar is posterior to buccal groove of Mandibular 1st molar
What are S/Sx of a severe oral/perioral infection?
Dyspnia Dysphagia Severe trismus Fever and swelling ABX resistant
What is a life threatening sequel to a severe oral/perioral infection?
Septicemia
Airway obstruction
Cavernous sinus thrombosis
Ludwigs angina
What are the four primary maxillary space infections?
Canine- infected maxillary canines
Buccal- infected maxillary and mandibular pre/molars
Vestibular abscess
Palatal abscess
Primary mandibular spaces and the infections that reside there
Submental- madibular incisors Buccal- infected maxillary/mandibular pre/molars Submandibular- mandibular pre/molars Sublingual- mandibular pre/molars Vestibular abscess
Define Ludwig’s Angina
Bilateral involvement of sublingua, submental and submandibular spaces
What is the purpose of I&D?
Remove pus/debris/bacteria in abscesses/cellulitis
Reduce tissue tension
Changes oxygen tension
What are the steps of an I&D procedure?
Nerve block
Incise area of max flactulance
Blunt dissection and copious irrigation
Insert/stabilize a drain
When/why would you follow up an I&D with ABX?
Swelling w/ systemic problem
Pericornitis w/ systemic problems
Facial space infections
Compromised host defenses
What are the risks of ABX use?
Allergy
Toxicity
C Diff
Resistant strains
Oral infection considerations for ABX therapy?
Polymicrobic
Broad spectrum
Culture
Systemic protection
What are five scenarios ABX are not used?
Chronic/localized abscess Dental sinus tract (fistula) Alveolar osteitis Pericornitis w/out systemic involvement Vestibular abscess w/out systemic Routine root canal
What is the ABX of choice for odontogenic infections?
Amoxicillin- broad spectrum, bacericidal against Gram-Pos/Neg that’s more absorbed in GI than PenVK
Low protein binding to inc bioavailability
How much Amoxicillin is used?
1000mg loading dose
Maintain- 500mg PO x 8hrs x 7 days
When is Augmentin used?
Amoxicillin and Clavulanic Acid combo
When Sx don’t improve s/ amoxicillin
Inc spectrum in persistent infections but is $$
Risk of GI/hepatic toxicity from severe anaphylactic allergic reactions
How much Augmentin is used?
Clavulanic Acid- 125mg PO x 8hrs x 5-7 days
When is Clindamycin used?
PT allergic to penicillin
Only a bacteriostatic for anaerobic bacteria but can penetrate bone
PT must stop at first sign of diarrhea or risk 8x inc of C Diff
How much Clindamycin is used?
Loading- 600mg
Maintain- 300mg PO x 6hrs x 7days
Define Tori
Variation of normal that is composed for normal bone and covered by normal mucosa on hart palate of maxilla/lingual side of teeth in mandible
Define Exosstosis
Variation of normal composed of normal bone and covered by normal mucosa on buccal side of maxillary/mandibular teeth
Define Benign Migratory Glossitis
Geographic tongue
What type of PT population is fissured tongue found in?
Melkersson-Rosenthal Syndrome
Down Syndrome
Xerostomia PTs
How to distinguish lingual varicosities from pathological issue?
Asymptomatic that blanches
Define Linea Alba
White raised ridge of tissue that’s horizontally or bilaterally from benign hyperkeratosis of buccal mucosa
Define Lichen Planus
Benign developmental variation of normal buccal mucosa
White/yellow thin lines forming lace-like pattern bilateral pattern
Define the pathognomonic sign Wickham’s Striae?
What causes this?
Lichen Planus
Auto immune response to damage on basal cells of oral epithelium, only topical steroids to treat if erosive/painful
Define Hairy Leukoplakia and it’s cause
Parallel hair-like white lesions on lateral tongue surface made of Candida Albicans from the Epstein Barr virus or HIV exposure
Treat HIV and Acyclovir and anti-fungals
Define Leukoplakia
White patch that does not rub off due to thickened surface keratin layer
Only clinical name, doesn’t imply histopathologic tissue alteration
Considered pre-malignancy
Define Candidiasis
Curdy white layer that leaves inflammed base when wiped off from Candida Albicans that presents as burning, dysgeeusia and can be co-infected with Staph
Acute- atrophic red patches or white/curd colonies
Chronic- denture related form confined to area
What are the local and systemic risks of a Candidiasis infection?
Local: Topical steroids, Broad spectrum antibiotics , Xerostomia, Heavy smoking
Systemic- poorly controlled DM, immunosuppressed, leukemia PTs, infants
How are Cadidiasis infections treated?
Nystatin suspension
Clotrimazole
Ketoconazole tabs
Fluconazole tabs
Define Angular Cheilitis
Dry cracks on commissures from candida albicans infections from excessive sun exposure, anemia or denture wearers treated w/ antifungals
Define Black Hairy Tongue
Elongation of filiform papillae, papillae grow longer and don’t shed due to bad oral hygiene, ABX use, tobacco or coffee/tea
How is Black Hairy Tongue treated?
Improve oral hygiene
Superoxide mouth rinse
Topical antifungal
Smokeless tobacco can cause what visible changes to mucosa?
Keratosis- white wrinkled mucosa in mandibular vestibule at the site of placement OR from osmotic water loss
Reversible within two weeks of cessation
Define Nicotinic Stomatitis
Benign variation of normal buccal mucosa that looks like white inflamed opening to minor salivary glands from heat generated from pipes or prolonged tobacco exposure
Reversed with cessation
How does mucosal allergy present?
Circumscribed erythematous patches at site of contact that’s treated with corticosteroids and antihistamines
Define Glossitis and how’s it treated
Enlarged tongue causing inability to close lips
Samyloidosis, Downs, Beckwith-Wiedemann Syndrome and hypothyroidism
Define Ankyloglossia
Tongue tied
How does a traumatic ulcer present?
Rolled white border of hyperkeratosis at area of trauma (chemical, thermal or mechanical cheek biter)
Treated w/ topical peroxide and avoid biting
Aphthous ulcer only grow on what type of tissue?
Non-keratinized
Define primary herpetic gingivostomatitis
Vesicle that progresses to ulcers with red halos that can spread during asymptomatic saliva from HSV-1
Possible fever malaise and lymphadenopathy
What meds can be used for Primary Herpetic Gingivostomatitis
Acetaminophen
Severe cases- Acyclovir
Primary Herpetic Gingivostomatitis activates but then goes dormant in which CN?
CN5 sensory ganglia of oral and perioral regions
Define Herpangina/Herpetic Whitlow
Herpes in the finger
How does primary syphilis present?
What type of microbe transmits it?
Painless lesion w/ central depression at site of inoculation
Treponema pallidum bacteria
How does secondary syphilis present?
Gray/white plaques covering ulcerated mucosa appearing 6wks after primary chancre appeared
Will have rash on hands, feet and body
MOST infectious stage of syphilis
Define Amalgam tattoo
Blue/purple dot on alveolar soft tissue from accidental implantation during amalgam restoration proximal to tattoo
Define hemangioma
Vascular anomaly from rapid growth phase of endothelial cell proliferation
Blanches to touch
Define Hematoma
Red/brown/blue lesion that does NOT blanch to pressure
Doesn’t resolve in 2wks, consider Dyscrasia
What are the different sizes of petechiae, purpura, and ecchymosis?
Petichiae: 1-2mm
Purpura: 2mm-2cm
Ecchmosis: >2cm
What can cause petechiae, purpura, and ecchymosis?
Trauma
Systemic Dz
Clotting disorder
Mono
Define melanotic macule
Painless tan/brown macule less than 0.5cm from genetics/solar radiation
Define Melanocytic Nevus
Intraoral mole/freckle less than 0.5cm in diamter that’s usually raised and has a smooth surface
Benign proliferation of melanocytes
What types of cells make up the majority of neoplasms in the oral cavity?
SCC- 90%, flat squamous arranged like scales
Verrucous- 5%, squamous, rarely spreads
Where does minor salivary gland carcinoma occur?
Lining oropharynx and hard palate
What are the neoplasm lymphomas of the oral cavity?
Non/Hodgkin
What are the benign tumors of the oral cavity?
Leukoplakia Erythroplakia Pyogenic Grauloma Fibroma
When are Kaposi Sarcoma seen?
Painless blue/purple macule that’s a tumor of vascular proliferation from cytomegalovirus usually seen in HIV Pts treated with retro-viral therapy
Characteristics of Squamous Cell Carcinoma
Deep ulcerated mass w/ possible local pain, referred pain to ear or parasthesia of lip
Caused by tobacco, alcohol, solar radiation or genetics
How are Squamous Cell Carcinoas biopsied?
Brush biopsy
Define Squamous Papilloma
Painless solitary white lesion with narrow base caused by local trauma or HPV
Define Cerruca Vulgaris
Common Wart
Painless solitary lesion with pedunculated/broad base usually occurring on labial mucosa and tongue from HPV-2/4/40
Define Condyloma Acuminatum
Painless multiple nodules on broad base in clusters usually on lip, tongue or soft palate caused by HPV-6/11/16/18
Define Inflammatory Papillary Hyperplasia
Painless erythematous nodules from ill fitting dentures and poor hygiene (possible candidiasis infection)
Define Pyoenic Granuloma
Pregnancy tumor
Red elevated lesion in between interproximal papillae from local factors/hormonal changes
Define Irritation Fibroma
Firm solitary nodule on buccal mucosa on labial mucosa, tongue and gingiva from reactive hyperplasia of CT in response to trauma/mechanical erosion
Define Epulis Fissuratum
Painless excessive nodular tissue with crease where dentur sits from hyperplasia caused by fibrous CT changes from ill-fitting dentures
Define Mucocele
Traumatic rupture of minor salivary gland and accumulation of saliva
Define Ranula
Block of major salivary duct causing accumulation of saliva, usually caused by sialolith or local trauma
What is the acronym for primary teeth eruption times?
CI LI M C M
6 9 13 16 23
What’s the acronym for permanent teeth eruption times?
M IC IL C M
6 6 7 9/11 11/12
What is the plaque formation timeline?
Mins- pellicle and adhesion 2hrs- aerobic gram pos 6hrs- plaque established 2days- doubled mass 5-7 days- gram neg and filamentous bacteria dominate 21- plaque accumulation stabilizes
Caries process involves demineralization of what three things?
Enamel
Dentin
Cementum
During the caries process dental plaque metabolize fermentable carbs into ?
Organic acids
Once below critical pH, enzymes break down organic component
Saliva’s pH
Enamal begins to demineralize at what pH?
6-8
5.5
What are the hallmark signs and symptoms of unhealthy gingiva?
Dolor Calor Rubor Tumor Functio laesa
What can cause Xerostomia?
Systemic Diseases
Gland damage fro surgery/radiation
Medication s/e
What microbe is present in NUG and pericornitis?
Treponema denticola
What does each microbe of the Red Bacterial Comples do?
T.F.: forms biofilm, produces cysteine proteases
T.D: pericornitis and NUG, produces proteolytic enzymes to degrade collagen
P.G: keystone pathogen for periodontal disease process, chiefly responsible for bone loss
Define Dental Anesthesiology
Science of managing pain/anxiety for overall PT health during procedures
Define Endodontics
Morphology, physiology, and pathology of pulp
Biology of normal pulp, etiology/prevention of diseases and injuries to pulp
Define Oral/Maxillofacial Pathology
Diseases of oralmaxillofacial regions
Define OMFS
Surgical/adjunct treatment of disease/injury to hard and soft tissue of oral and maxillofacial region
Define Orthodontics and Dentofacial Orthopedics
Malocclusions, neuromuscular and skeletal abnormalities
Define Periodontics
Supporting/surrounding tissues
Define Prosthodontics
Missing teeth or tissues
Dental Class 1-3 questions?
Restoration
Any -dontic
Surgery
Oral pathology
How does a periapical abscess present?
Edema
Sensitive to percussion/palpation
No response to cold
How does a periodontal abscess present?
Throbbing pain Edema Mobile tooth Foul taste Gingival enlargement lateral to tooth
How is inflammatory papillary hyperplasia treated?
Remake dentures
Treat Candidiasis
Surgical removal of lesions
What drugs are given for geographic tongue?
Topical anti-inflammatory agents:
- Triamcinolone (Kenalog in Orabase)
- Fluocinonide (Lidex)
What drug is used for mucosal allergy?
*Triamcinolone (Kenalog in Orabase)
What drug is given for apthous ulcer?
*Triamcinolone (Kenalog in Orabase)
Decadron elixir rinse QID
Of the oral pathology, what three have bases and which one is uniquely pendunculated?
Squamous papilloma- pedunc.
Verruca- broad
Condyloma- broad
What are the S/Sx of gingivitis inflammation?
BP HELPERS Bleeding Pain Heat Edema Loss of stipling Purulence Erythema Receding margin Shiny
Acronyms for remembering microbe data?
PG- GRAN
Tanner- NG SOAP
Treponema- MANGS
Non-surgical care for periodontal disease should be conducted how often?
3mon
