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ICM Unit 3 HEENT > Diseases of the Mouth and Salivary Gland > Flashcards

Diseases of the Mouth and Salivary Gland Flashcards

1
Q

Aphthous Ulcers

A

AKA Canker sore

? associated with human herpes virus 6
STRESS is a major predisposing factor!

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2
Q

Aphthous Ulcers Common location

A

Typically found on buccal and labial mucosa
Spares gingival and palatal mucosa

Common & easy to identify

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3
Q

Aphthous Ulcers S/S

A

Single or multiple
Often recurring
Painful
Small, round ulcerations with yellow-gray
centers surrounded by red halos

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4
Q

Aphthous Ulcers Tx

A

Minor (<1cm)—generally heal, 10 -14 days
Major (>1cm)—can be disabling due to pain

  • If large or not improving, consider biopsy

Symptom care
Salt water or medicated rinses (swish and spit)
Cimetidine (Tagamet) has been helpful in patients with recurrent ulcers

!! Topical steroids (triamcinolone, in adhesive base (Orobase))

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5
Q

Aphthous Ulcers

Large or persistent areas may be caused by

A

erythema multiforme, drug allergies, HSV, bullous or pemphigus diseases, Behcet disease or inflammatory bowel disease

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6
Q

Necrotizing Ulcerative Gingivitis

A

AKA “Trench Mouth” and Vincent Angina”

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7
Q

Necrotizing Ulcerative Gingivitis - cause

A

infection of the gums with spirochetes & fusiform bacteria

sudden onset

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8
Q

Necrotizing Ulcerative Gingivitis - common in

A

young adults in times of stress

underlying systemic disease

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9
Q

Necrotizing Ulcerative Gingivitis - S/S

A

Gums - tender and inflamed

Affected gingiva between teeth ulcerates and may be covered with a gray exudate which can be removed with gentle pressure

F/tender, bleeding gums, halitosis and cervical lymphadenopathy

bad smelling breath

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10
Q

Necrotizing Ulcerative Gingivitis - Tx

A

Warm half-strength peroxide rinses or other antibacterial rinses

Oral antibiotics- Penicillin and Metronidazole

Debridement ?

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11
Q

Herpes Stomatitis - type and cause

A

HSV Type 1

Prodrome: burning/tinging

Then, small vesicles form that rupture and form scabs

Problematic in the HIV population- more frequent and potentially severe

stress can bring this on

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12
Q

Herpes stomatitis - lesion location

A

attached gingiva and mucocutaneous junction of lip, tongue, buccal mucosa and soft palate

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13
Q

Herpes stomatitis -

Primary infxn symptoms

A

malaise, fever, headache and cervical lymphadenopathy

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14
Q

Herpes stomatitis -

Recurrences

A

usually occur on the LIPS

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15
Q

Herpes stomatitis - Tx

A

Adults : common, mild and short-lived; typically requires no intervention - symptomatic care

oral acyclovir, valacyclovir (or topical)

(Usually only effective if started within 24-48 hours of onset of symptoms)

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16
Q

Primary syphilis

A

Chancre

Single, indurated painless ulcer on the mucosa

Resolves spontaneously, 4 - 6 weeks

bx can help with dx

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17
Q

Secondary Syphilis

A

a well-defined white plaque on the labial or palatal mucosa =

(CONDYLOMA LATA)

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18
Q

Oral Candidiasis cause

A

overgrowth of candida species

MC in either systemic or local immunosuppression!

(steriods, chemo/rad, abx use, HIV, DM, dentures)

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19
Q

Oral Candidiasis - common in

A

the elderly and very young

individual who use powder inhalers (Recommend rinsing, swishing and spitting after use)

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20
Q

Oral candidiasis - tongue blade use

A

DOES scrape off and reveals eryth. base

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21
Q

Oral candidiasis - S/S

A

Throat or mouth pain

Erythema of the oral cavity, Creamy, white patches/plaques

May have associated burning, may be worse with certain foods/drink

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22
Q

Oral candidiasis - Dx

A

Clinical

wet prep/bx if needed

Consider HIV testing

HIV + pts, oral exam every visit & dental visits every 6 mos.

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23
Q

Oral candidiasis - Tx

A

Antifungal therapy

Topical: Clotrimazole troches or Nystatin solution (1st line usually)

Oral: Fluconazole, Ketoconazole (not common)

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24
Q

Oral candidiasis can spread

A

down esophagus and throat/pharynx

same tx - swish and swallow

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25
Q

Mucoceles

A

Cystic lesions found in the mouth, usually lower lip (oral mucousa!)

Common, benign

develop following trauma (self-biting) or obstruction of a minor salivary gland

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26
Q

Mucoceles - S/S

A

Variable in size, contains gelatinous fluid

Nodule, with a thick roof

Chronic lesions = firm, inflamed, poorly circumscribed nodules; bluish, translucent; fluctuant

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27
Q

Mucoceles - Dx

A

clinical,

biopsy if needed

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28
Q

Mucoceles - Tx

A

Avoid any further trauma = resolution

Excision if not improving, bothersome or progressing

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29
Q

Ranula

A

found under tongue!

May be small and well circumscribed or “plunging”

similar to mucocele

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30
Q

Ranula - tx

A

can be excised but need to go down to base to avoid recurrence

resolve on their own if small usually

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31
Q

Glossitis

A

Inflammatory disorder of the tongue

loss of filiform papillae

rarely painful

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32
Q

Glossitis - Appearance

A

smooth, glossy appearance with red or pink background

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33
Q

Glossitis - causes

A

Nutritional deficiencies (B12, Niacin, Riboflavin, Iron, Vit E)
Drug reactions
Dehydration
Malnutrition- protein/calorie deficit
Certain irritating foods and liquids
Autoimmune disorders- Sjogren’s, Celiac

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34
Q

Glossitis - Tx

A

underlying cause / improve nutritional diet

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35
Q

Glossodynia

A

AKA “Burning Mouth Syndrome” or burning tongue

Burning and pain of the tongue +/- glossitis

MC in post-menopausal women

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36
Q

Glossodynia - associated with

A

Diabetes Mellitus
Drugs (diuretics)
Tobacco
Xerostomia (dry mouth)
Candidiasis

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37
Q

Glossodynia - Tx

A

underlying causes, change long-term meds, smoking cessation

Meds (if needed): clonazepam

Behavioral therapy may be helpful

If occurring on only one side of tongue, neurologic lesions need to be ruled out

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38
Q

Fissured tongue

A

Deep grooves located on the midline or evenly distributed on the tongue surface

Can be a normal tongue variant seen in adults

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39
Q

Fissured tongue - Tx

A

generally asymp.

although if irritation from entrapped debris occurs, brushing the tongue may be helpful

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40
Q

Fissured tongue - associated w/

A

malnutrition, Down Syndrome, Vitamin B deficiency

predisposing factor for halitosis

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41
Q

Black tongue

A

Hyperpigmentation of the tongue and oral mucosa

commonly seen in dark-skinned individuals

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42
Q

Black Tongue - less common causes

A

drugs (tetracyclines, bismuth subsalicylate)

proton pump inhibitors Addison disease

pellagra (niacin deficiency)

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43
Q

Black Hairy Tongue

A

harmless, temporary cond. - tongue discoloration

Buildup of dead cells on the papillae

papillae easily trap bacteria, yeast, tobacco, food or other substances

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44
Q

Black Hairy Tongue - tx

A

Resolves by eliminating cause & by practicing good oral hygiene

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45
Q

Angular Chelitis

A

Acute or chronic inflammation of the labial mucosa at the lateral commissures

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46
Q

Angular Chelitis - Causes

A

Excessive moisture from saliva - (secondary infxn = candidiasis or S. aureus)

More common in older age, denture wearers, poor oral hygiene

Nutritional deficiencies, in younger patients- lip licking, thumb sucking, drooling

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47
Q

Angular Chelitis - S/S

A

Erythema, maceration, scaling, fissuring

painful, usually bilateral

ulceration, crusting, cracking

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48
Q

Angular Chelitis - Dx

A

clinical
culture?
KOH prep?

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49
Q

Angular Chelitis - Tx

A

improve denture fit/hygiene,
optical oral hygiene,
barrier creams/ointment,
topicals

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50
Q

Geographic tongue

A

AKA benign migratory glossitis

Recurrent inflammatory disorder - unknown etiology - affects the dorsum of the tongue

areas of atrophy

lesions change location, pattern, size, and migrate

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51
Q

Geographic tongue - s/s

A

usually asymp.

sometimes sensitive or painful w/ certain foods/ drinks

may be associated w/ atopy, psoriasis, or reactive arthritis

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52
Q

Geographic tongue - Dx

A

clinical

bx for DDX

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53
Q

Geographic tongue - Tx

A

none necessary

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54
Q

Hairy Leukoplakia

A

NOT premalignant

common early finding of HIV

also seen in organ transplant pts

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55
Q

Hairy Leukoplakia - cause

A

EBV

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56
Q

Hairy Leukoplakia - appearance and location

A

Slightly raised leukoplakic areas with a “hairy” surface

commonly lateral border of tongue

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57
Q

Hairy Leukoplakia - Tx

A

nonspecific

improves w/ antiretroviral meds to treat HIV

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58
Q

Gingival hyperplasia

A

develop as a result of inflammation in response to long-standing gingivitis

in children OR due to certain medications

59
Q

Gingival hyperplasia - medication causes

A

phenytoin, cyclosporine, calcium channel blockers

60
Q

Gingival hyperplasia - tx

A

if isolated - consider bx

61
Q

Gingivitis

A

MC form of periodontal gum dz
(precursor to periodontitis)

62
Q

Gingivitis - S/s

A

Inflammatory (red/ swelling)

bleeding may occur w/ brushing/flossing

63
Q

Gingivitis - Tx

A

Good, regular, oral hygiene

Regular dental check-ups and removal of tartar/plaque

64
Q

Periodontitis

A

Gingival inflammation accompanied by loss of supportive connective tissue

chronic form MC in adults - lead to destructino of periodontium and tooth loss

65
Q

Dental Caries - cause

A

microbs that make acids on tooth surface from di/monosaccharides

demineralization of enamel

tooth decay

66
Q

Dental Caries - S/S

A

initially asymp.

pain

temp. sensitivity

67
Q

Dental Caries - Tx

A

filings

68
Q

Dental Caries - prevention

A

regular dental care (fluoride toothpaste)

dietary changes

69
Q

Dental Abscess

A

Infxn, pocket of pus, around tooth - untreated cavity, an injury or from prior dental work

70
Q

Dental Abscess - periapical

A

tip of root

71
Q

Dental Abscess - periodeontal

A

in the gums at the side of the tooth root

72
Q

Dental Abscess - s/s

A

toothache
temp. sensitivity
swelling face/cheek
swollen/tender lymph nodes

73
Q

Dental Abscess - Dx

A

X-rays, CT for extent of infxn (can lead to airway compromise if untxed)

74
Q

Dental Abscess - Tx

A

oral abx
abx rinses

I&D, root canal, dental extraction
page Dentistry not ENT

75
Q

Ludwig’s Angina

A

Suppurative odontogenic infection which extends to the facial spaces

BILATERAL submandibular spaces!!

76
Q

Ludwig’s Angina - s/s

A

Usually secondary to infected 2nd or 3rd mandibular molar

Aggressive, rapidly spreading cellulitis
WITHOUT lymphadenopathy
WITH potential for airway obstruction

77
Q

Ludwig’s Angina - Dx

A

clinical
CT imaging of choice

palpate floor of mouth!! which should be elevated

78
Q

Ludwig’s Angina - Tx

A

1st- MANAGE AIRWAY
IV abx
if abscess - drain

79
Q

Leukoplakia

A

white lesion, patch or plaque of the oral mucosa

CANNOT be removed by rubbing the mucosal surface

benign, 6% dysplastic or early SCC

80
Q

Leukoplakia - causes and location

A

to chronic irritation (dentures, smokeless tobacco, lichen planus)

lateral mouth, inside lip, lateral tongue

81
Q

Leukoplakia - Dx

A

Bx to rule out cancer

(esp. if enlarging, indurated or ulcerative and extending deeper than submucosa)

82
Q

Leukoplakia - DDx

A

thrush, lichen planus

83
Q

Leukoplakia - Tx

A

nothing specific

84
Q

Erythroplakia

A

Red, mucosal plaques

definite erythematous component (unlike leukoplakia - similar tho)

85
Q

Erythroplakia - common in and locations

A

older men

lateral tongue, floor of mouth, soft palate, alveolar ridge

86
Q

Erythroplakia - Dx

A

Bx - 90% malignant (look for erythroplakia in leukoplakia!)

87
Q

Erythroplakia - Tx

A

nothing specific

88
Q

Oral lichen planus

A

Chronic inflammatory autoimmune disease

89
Q

Oral lichen planus - appearance

A

Lacy/Reticular leukoplakia , may be erosive

can vary significantly
May mimic other diseases (candidiasis, hyperkeratosis, SCC)

90
Q

Oral lichen planus - DX

A

bx required to prove dx and rule out other dz

91
Q

Oral lichen planus - TX

A

manage pain and discomfort

topical CS

92
Q

Oral and Oropharyngeal Cancer

A

Any cancer arising within the oral or oropharyngeal cavity

93
Q

Oral cancers: 90%

A

90% Squamous Cell Carcinoma

94
Q

Oropharyngeal: significant association with

A

HPV

95
Q

Oral and Oropharyngeal Cancer

Major risk factors

A

Increased age (esp >45)
Tobacco use (chewing and smoking)
Alcohol use

96
Q

Oral and Oropharyngeal Cancer - who needs bx

A

Any area of erythroplakia
Any enlarging area of leukoplakia
Any lesion that has submucosal depth on palpation
Ulcerative lesions

97
Q

Oral and Oropharyngeal Cancer - locations

A

Lateral tongue
Floor of the mouth
Gingiva
Buccal area
Palate
Tonsillar fossa
+ palpation of the neck for enlarged lymph nodes

98
Q

Oral cancer

Early lesions appear as…
More advanced lesions -

A

as leukoplakia or erythroplakia

  • larger, with invasion into the tongue (may be palpable or ulceration)
99
Q

Oral cancer - s/s and location

A

early - painless and subtle physical changes

majority - ant 2/3 of tongue and floor of mouth

100
Q

Oral cancer - tx

A

early detection key!

<4mm = less likely metatasize
<2cm = local resection

Larger lesions = combo resection, neck dissection, and external beam radiation

101
Q

Oral cancer - prognosis

A

dependent on stage at dx

stage 1 about 90%, higher stages about 60%

102
Q

Oropharyngeal Cancer arising in the …

A

soft palate, tonsils, base of tongue, pharyngeal wall and vallecular

103
Q

Oropharyngeal Cancer - MC

A

SCC and presents later than oral cavity CA

104
Q

Oropharyngeal Cancer - risk factors

A

similar to oral CA

105
Q

Oropharyngeal Cancer - signficant assoc. w/

A

HPV infxn (70%) - respond well to RADIATION

106
Q

Oropharyngeal Cancer - S/s

A

unilateral throat masses (1 large tonsil = abnormal)

painful swallowing

weight loss

ipsilateral cervical lymphadenopathy

persist. sore throat, diffi. swallowing, voice changes, cough, lump in throat/neck

107
Q

Oropharyngeal Cancer - dx

A

bx

eval for metastases

108
Q

Oropharyngeal Cancer - Tx

A

surgical resection tumors + external beam rad +/- chemo

109
Q

Sialadenitis

A

Acute infection of the salivary gland
MC parotid or submandibular

Retrograde bacterial contamination from the oral cavity

110
Q

Sialadenitis - process

A

Ductal obstruction -> mucous plug -> salivary stasis -> secondary infection

111
Q

Sialadenitis - MC bacterial cause

A

S. aureus

112
Q

Sialadenitis - other causes

A

strep species, H. influ

113
Q

Sialadenitis - s/s

A

Acute swelling of the gland
Bad taste
Fever
Dry mouth
Increased pain and swelling with meals due to duct obstruction
Tenderness and erythema of the duct opening

114
Q

Sialadenitis - Tx

A

IV/oral abx
Hydration
warm compresses
Sialagogues (lemon drops, sour candy or Pilocarpine)
Gland massage

imaging and refer if no improvement

I&D?

115
Q

Sialadenitis - complications

A

Abscess
Stricture
Stone
Tumor
Suppurative sialadenitis

116
Q

Parotitis

A

Acute infection of the parotid gland

117
Q

Parotitis - s/s and dx

A

neck swelling - parotid tail rides low

look inside mouth and press - purulence draining from parotid duct

rule out mumps in kids w/ parotid/facial swelling

118
Q

Parotitis - tx

A

typically non-surgical

119
Q

Acute Suppurative Sialadenitis

A

Typically one major salivary gland is affected

Usually the parotid

120
Q

Acute Suppurative Sialadenitis - s/s

A

Pain and swelling of the affected gland
Induration
Tenderness
Massage of the gland may express pus from intraoral orifice

121
Q

Acute Suppurative Sialadenitis - Tx

A

warm compresses
sialogagues
oral hygiene
oral abx (augmentin)

122
Q

Sialolithiasis

A

Formation of a stone in the salivary ductal system

Most common: Wharton duct- submandibular gland

123
Q

Sialolithiasis - s/s

A

Large, radiopaque

Less common- Stensen duct- parotid gland
Smaller, radiolucent

post-prandial pain and local swelling
may have recent history of sialadenitis

124
Q

Sialolithiasis - dx

A

NCCT if stone not palpable (imaging of choice)

125
Q

Sialolithiasis - Tx

A

Hydration
Warm compresses
Sialogogues
Analgesics
Refer to ENT for removal or if severe symptoms and not responding

126
Q

Chronic Salivary Disorders

A

Inflammatory or infiltrative

Unilateral or bilateral parotid gland enlargement

Lymphoephithelial/granulomatous diseases:
- Sjogren’s
- Sarcoidosis

127
Q

Chronic Salivary Disorders

Metabolic disorders

A

Alcoholism
DM
Vitamin def.

128
Q

Chronic Salivary Disorders

Certain drugs

A

Thioureas, iodine, cholinergics

Any medication that stimulates salivary flow and causes more viscous saliva

129
Q

Salivary Gland Tumors

A

MC site : parotid gland (80%)

benign 80% - MC tumor = pleomorphic adenoma (but potential to become malign.)

tumors of submandibular 40-50% malig

130
Q

Salivary Gland Tumors

MC malignant tumors

A

Mucoepidermoid carcinoma
Adenoid cystic carcinoma

131
Q

Salivary Gland Tumors S/S

A

slow growing
painless masses

facial n. involve strongly corresponds to malign

132
Q

Salivary Gland Tumors - Dx

A

fine needle aspiration (FNA) vs. excision

FNA is old or too unhealthy for surgery

133
Q

Salivary Gland Tumors - Tx

A

refer ENT

134
Q

Salivary Gland Tumors - prog

A

5 yr survival rate about 72%

varies on stage and type

135
Q

Xerostomia

A

AKA “dry mouth”

Salivary glands do not make enough saliva to lubricate the mouth

136
Q

Xerostomia - causes

A

Med SE: Antihistamines, antidepressants, antipsychotics, parkinson’s disease medications, diuretics, neuroleptics, anti-cholinergic medications

untreated depression

Radiation of head or neck

137
Q

Xerostomia - tx

A

Sialogogues
Freq. sips water
Ice chips,
Saliva substitutes- sprays (biotene)

Change/adj meds

oral pilocarpine

cavity prevention - overnight fluoride trays

138
Q

Xerostomia - complications

A

dental caries

parotid gland enlargement

fissuring lips

oral candidiasis

halitosis

ulcers/inflamm of tongue

139
Q

Torus Palatinus

A

Bony overgrowth (exostosis) -midline of the hard palate

very common - develops during childhood and enlarges over time slowly

140
Q

Torus Palatinus - appearance

A

a bony, hard, nodular, lobular, or spindle-shaped mass covered with normal mucosa

141
Q

Torus Palatinus - s/s and dx

A

gen. asymp.

rapid change/growing, not on midline, or atypical appearance = refer for imaging/bx

142
Q

Torus Palatinus - tx

A

surgical removal (symptomatic or protruding fit of dental devices)

143
Q

Torus mandibularis (mandibular exostoses)

A

lingual,

More common than torus palatinus

ICM Unit 3 HEENT (6 decks)

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