EXAM 1 Oral Cavity

Question 1

• calcium hydroxyapatite

- It is hard, inert, acellular tissue (hardest in body)

Answer 1

enamel

Question 2

contains cells (odontoblasts) which can produce new dentin

Answer 2

dentin

Question 3

consists of loose connective tissue rich in nerves, lymphatics and capillaries

Answer 3

pulp chamber

Question 4

• provide a strong and flexible attachment

- They attach to the alveolar bone of the jaw on one side and to cementum, which anchors the ligament to the tooth

Answer 4

periodontal ligaments

Question 5

covers bony surfaces

Answer 5

gingiva

Question 6

One of the most common diseases, the most common cause of tooth loss before age 35

Answer 6

dental caries

Question 7

Improved oral hygiene and fluoridation of the drinking water has _____ caries risk

Answer 7

Improved oral hygiene and fluoridation of the drinking water has reduced caries risk

Question 8

Increased “Westernization” of global diet is dramatically _______ risk of caries in developing countries

Answer 8

Increased “Westernization” of global diet is dramatically increasing risk in developing countries

Question 9

Result from demineralization of tooth structure by acids, produced from bacterial metabolism of sugars

Answer 9

dental caries

Question 10

Streptococcus mutans and Lactobacillus most common cause of:

Answer 10

dental caries

Question 11

_______ incorporates into the crystalline structure of enamel, forming fluoroapatite, which is resistant to bacterial acids

Answer 11

Fluoride incorporates into the crystalline structure of enamel, forming fluoroapatite, which is resistant to bacterial acids

Question 12

squamous mucosa between and around the teeth

Answer 12

gingiva

Question 13

inflammation of the gingiva and associated soft tissues

Answer 13

gingivitis

Question 14

-Usually caused by accumulation of dental plaque

Answer 14

gingivitis

Question 15

____ _____ is a “biofilm” of bacteria, saliva and bacterial proteins, and desquamated epithelial cells on and between teeth

Answer 15

Dental plaque is a “biofilm” of bacteria, saliva and bacterial proteins, and desquamated epithelial cells on and between teeth

Question 16

With time, dental plaque becomes mineralized to form ______ (_____)

Answer 16

With time, dental plaque becomes mineralized to form calculus (tartar)

Question 17

Plaque bacteria metabolize ____, releasing ____ which cause caries

Answer 17

Plaque bacteria metabolize sugar, releasing acids which cause caries

Question 18

Bacterial proteins and metabolic products promote ______ ________, i.e., gingivitis

Answer 18

Bacterial proteins and metabolic products promote gingival inflammation, i.e., gingivitis

Question 19

characterized by gingival erythema, edema, bleeding, changes in gingival contour, and altered tooth attachment

Answer 19

chronic gingivitis

Question 20

Associated with risk for periodontitis

Answer 20

gingivitis

Question 21

caused by inflammation of the supporting structures of the teeth, including the periodontal ligaments, alveolar bone, and cementum

Answer 21

periodontitis

Question 22

Results in loss of attachment due to destruction of periodontal ligaments and loss of alveolar bone

Answer 22

periodontitis

Question 23

Periodontitis is related to change in oral bacterial ____

Answer 23

Periodontitis is related to change in oral bacterial flora

Question 24

Associated with complications with pregnancy, endocarditis, abscess

Answer 24

periodontitis

Question 25

- Associated with certain diseases like HIV/AIDS, diabetes, other immune deficiency states - Associated with increased risk for developing diabetes, heart disease, other systemic disease

Answer 25

periodontitis

Question 26

- Most common nodular oral mass | - Primarily occurs in the buccal (cheek) mucosa along the bite line or at the gingivodental margin

Answer 26

irritation fibroma

Question 27

- A nodular mass of fibrous tissue, with few inflammatory cells, covered by squamous mucosa - Associated with repeated injury (chronic inflammation)

Answer 27

irritation fibroma

Question 28

- Relatively common chronic inflammatory nodule derived from cells of the periodontal ligament - Results from chronic irritation

Answer 28

peripheral ossifying fibroma

Question 29

- Occurs on the gingiva between the teeth (interdental papilla) - Peak incidence in young and teenage females

Answer 29

peripheral ossifying fibroma

Question 30

- Red or pink in color - Smooth or pebbled irregular surface - Ulcerated or not - Broad base attachment, less often pedunculated

Answer 30

peripheral ossifying fibroma

Question 31

- A highly vascular pedunculated lesion (hanging on stalk) | - Usually on the gingiva of children, young adults, pregnant women (pregnancy tumor)

Answer 31

pyogenic granuloma

Question 32

- Typically has an ulcerated surface and red to purple color | - Can grow rapidly causing fear of cancer

Answer 32

pyogenic granuloma

Question 33

- Histologically are highly vascular similar to granulation tissue (chronic inflammatory lesion) - May develop into a peripheral ossifying fibroma

Answer 33

pyogenic granuloma

Question 34

-Single or multiple, shallow, hyperemic (red) ulcerations covered by a thin exudate and rimmed by a narrow zone of erythema

Answer 34

apthous ulcer

Question 35

- Inflammatory lesion with macrophages causing tissue injury and ulceration of oral mucosa - Cause unknown, can be found with celiac disease and inflammatory bowel disease - More common in the first two decades of life

Answer 35

apthous ulcer

Question 36

- Extremely painful and often recurrent | - Spontaneously resolve in 1-2 weeks but may persist for weeks

Answer 36

apthous ulcer

Question 37

- Inflammation to the tongue for any reason, including trauma, chemicals, infection, or metabolic - May be swelling, color changes, pain, papilla changes, or any combination of these - Includes changes to the tongue resulting from certain vitamin deficiencies (B vitamins) and iron deficiency

Answer 37

glossitis

Question 38

- Some presentations with no known cause (e.g., migratory glossitis) - Includes changes to the tongue resulting from certain vitamin deficiencies (B vitamins) and iron deficiency

Answer 38

glossitis

Question 39

highly resistant to normal bacterial flora

Answer 39

oral mucosa

Question 40

defenses of oral mucosa

Answer 40

- Normal flora is low virulence - Secretory IgA in saliva (antibody that blocks microbial attachment to mucosal surfaces) - Tonsils and adenoids (lymph nodules – like lymph nodes, site for lymphocyte exposure to oral antigens)

Question 41

Most bacterial infections of the oral mucosa are related to:

Answer 41

- Immunodeficiency (e.g., young, old, pregnant, disease) | - Disruption of the normal flora (e.g., antibiotics)

Question 42

cytomegalovirus, Epstein-Barr virus (EBV, infectious mononucleosis), varicella-zoster virus, other (130+)

Answer 42

other herpes family viruses

Question 43

- Typically occurs in children age 0.5 to 5 years | - infects at site of exposure and replicates in keratinocytes and epithelial cells (including mucosal epithelium)

Answer 43

viral oral cavity infections

Question 44

- Infection results in cell death (red-rimmed, painful ulcer) and inflammation (vesicles/bullae), positive Tzanck test (acantholytic [separated] keratinocytes, multinucleate giant cells, cytoplasmic inclusions) - Acute (initial) infection may be accompanied by lymphadenopathy, fever, anorexia, and irritability

Answer 44

viral oral cavity infections

Question 45

-Within 24 hours of infection, virus enters neuronal termini and is transported to sensory ganglia, continue to replicate and establish latency in ganglia Unique to HSV*

Answer 45

viral oral cavity infections

Question 46

Reactivation from latent infection results in anterograde axonal transport to terminals of affected sensory nerves, replication in epithelial cells forming lesions at site of primary infection

Answer 46

recurrent infection of herpesvirus

Question 47

- Frequently associated with immunosuppression, e.g., stress, diabetes, concurrent illness - Usually less severe presentation than primary infection

Answer 47

recurrent infection of herpesvirus

Question 48

Other viral infections of the oral cavity, head and neck

Answer 48

- enterovirus --> includes Coxackie A and B, Echovirus, other Enterovirus species i.e. hand-foot-and-mouth disease - rubeola virus --> measles

Question 49

fungus causing thrush

Answer 49

candida albicans

Question 50

Superficial infection of mucosal membranes by yeast, may extend into _____ (also found on other mucosal membranes, moist skin areas)

Answer 50

Superficial infection of mucosal membranes by yeast, may extend into esophagus (also found on other mucosal membranes, moist skin areas)

Question 51

- Most commonly presents with a superficial, curd-like, gray to white inflammatory membrane (a “pseudo-membrane” of yeast in a fibrinosuppurative exudate) - Readily scraped off to reveal an underlying erythematous inflammatory base

Answer 51

thrush

Question 52

Risk increased with immunodeficiency, change in mucosal flora (e.g., after antibiotics)

Answer 52

thrush

Question 53

____ fungal infections usually have higher morbidity, predilection for the oral cavity and the head and neck region

Answer 53

Deep fungal infections usually have higher morbidity, predilection for the oral cavity and the head and neck region

Question 54

- Manifested by deep ulcers with or without pseudomembranes, may also involve other tissues of head and neck (or elsewhere) - Risk higher in immunosuppressed populations

Answer 54

deep fungal infections

Question 55

``` Histoplasmosis, Blastomycosis Coccidioidomycosis Cryptococcosis Zygomycosis Aspergillos ```

Answer 55

deep fungal infections

Question 56

Scarlet fever, B-vitamin deficiency, iron deficiency, celiac disease, Sjögren syndrome associated with _____ changes

Answer 56

Scarlet fever, B-vitamin deficiency, iron deficiency, celiac disease, Sjögren syndrome associated with tongue changes

Question 57

Crohn’s disease, celiac disease associated with _____ ______

Answer 57

Crohn’s disease, celiac disease associated with aphthous ulcers

Question 58

Measles associated with ____ _____

Answer 58

Measles associated with Koplik’s spots

Question 59

Infectious mononucleosis, diphtheria, streptococcal pharyngitis associated with _________ _______

Answer 59

Infectious mononucleosis, diphtheria, streptococcal pharyngitis associated with pseudomembranous tonsillitis

Question 60

a white, thickened mucosal patch or plaque, usually with sharply demarcated borders, that cannot be scraped off

Answer 60

leukoplakia

Question 61

- Caused by hyperplasia of the squamous epithelium, occurs prior to dysplastic and neoplastic transformation - Also seen in purely inflammatory conditions not associated with malignancy

Answer 61

leukoplakia

Question 62

- Also seen in purely inflammatory conditions not associated with malignancy - Associated with human papillomavirus (HPV)

Answer 62

leukoplakia

Question 63

- Until proved otherwise (histology), all leukoplakias are considered ________ - 1-20% progress to carcinoma within ___ years

Answer 63

- Until proved otherwise (histology), all leukoplakias are considered precancerous - 1-20% progress to carcinoma within 10 years

Question 64

red, velvety plaque on epithelial/mucosal surfaces, may be at surrounding height or slightly depressed

Answer 64

erythroplakia

Question 65

Less common than leukoplakia and higher cancer risk

Answer 65

erythroplakia

Question 66

Histologically shows intense subepithelial inflammation with vascular dilation, giving the reddish clinical appearance

Answer 66

erythroplakia

Question 67

Virtually all (approximately 90%) have superficial erosions with dysplasia, carcinoma in situ, or already developed carcinoma

Answer 67

erythroplakia

Question 68

most common form of head and neck cancers (95%), usually arising in the oral cavity

Answer 68

squamous cell carcinoma

Question 69

__% of oropharyngeal cancers are associated with HPV

Answer 69

50% of oropharyngeal cancers are associated with HPV

Question 70

- May arise anywhere but usually the ventral surface of the tongue, floor of the mouth, lower lip, soft palate, and gingiva - Typically preceded by premalignant lesions (leukoplakia, erythroplakia)

Answer 70

squamous cell carcinoma

Question 71

- Start as raised, firm, pearly plaques or as irregular, roughened, or verrucous (wart-like) areas of mucosal thickening - As they enlarge, they typically create ulcerated and protruding masses that have irregular and indurated (rolled) borders

Answer 71

squamous cell carcinoma

Question 72

5-year survival rate of early-stage oral cancer is approximately __%, survival drops to __% for late-stage disease

Answer 72

5-year survival rate of early-stage oral cancer is approximately 80%, survival drops to 19% for late-stage disease