EXAM 1 Oral Cavity Flashcards
- calcium hydroxyapatite
- It is hard, inert, acellular tissue (hardest in body)
enamel
contains cells (odontoblasts) which can produce new dentin
dentin
consists of loose connective tissue rich in nerves, lymphatics and capillaries
pulp chamber
- 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
periodontal ligaments
covers bony surfaces
gingiva
One of the most common diseases, the most common cause of tooth loss before age 35
dental caries
Improved oral hygiene and fluoridation of the drinking water has _____ caries risk
Improved oral hygiene and fluoridation of the drinking water has reduced caries risk
Increased “Westernization” of global diet is dramatically _______ risk of caries in developing countries
Increased “Westernization” of global diet is dramatically increasing risk in developing countries
Result from demineralization of tooth structure by acids, produced from bacterial metabolism of sugars
dental caries
Streptococcus mutans and Lactobacillus most common cause of:
dental caries
_______ incorporates into the crystalline structure of enamel, forming fluoroapatite, which is resistant to bacterial acids
Fluoride incorporates into the crystalline structure of enamel, forming fluoroapatite, which is resistant to bacterial acids
squamous mucosa between and around the teeth
gingiva
inflammation of the gingiva and associated soft tissues
gingivitis
-Usually caused by accumulation of dental plaque
gingivitis
____ _____ is a “biofilm” of bacteria, saliva and bacterial proteins, and desquamated epithelial cells on and between teeth
Dental plaque is a “biofilm” of bacteria, saliva and bacterial proteins, and desquamated epithelial cells on and between teeth
With time, dental plaque becomes mineralized to form ______ (_____)
With time, dental plaque becomes mineralized to form calculus (tartar)
Plaque bacteria metabolize ____, releasing ____ which cause caries
Plaque bacteria metabolize sugar, releasing acids which cause caries
Bacterial proteins and metabolic products promote ______ ________, i.e., gingivitis
Bacterial proteins and metabolic products promote gingival inflammation, i.e., gingivitis
characterized by gingival erythema, edema, bleeding, changes in gingival contour, and altered tooth attachment
chronic gingivitis
Associated with risk for periodontitis
gingivitis
caused by inflammation of the supporting structures of the teeth, including the periodontal ligaments, alveolar bone, and cementum
periodontitis
Results in loss of attachment due to destruction of periodontal ligaments and loss of alveolar bone
periodontitis
Periodontitis is related to change in oral bacterial ____
Periodontitis is related to change in oral bacterial flora
Associated with complications with pregnancy, endocarditis, abscess
periodontitis
- Associated with certain diseases like HIV/AIDS, diabetes, other immune deficiency states
- Associated with increased risk for developing diabetes, heart disease, other systemic disease
periodontitis
- Most common nodular oral mass
- Primarily occurs in the buccal (cheek) mucosa along the bite line or at the gingivodental margin
irritation fibroma
- A nodular mass of fibrous tissue, with few inflammatory cells, covered by squamous mucosa
- Associated with repeated injury (chronic inflammation)
irritation fibroma
- Relatively common chronic inflammatory nodule derived from cells of the periodontal ligament
- Results from chronic irritation
peripheral ossifying fibroma
- Occurs on the gingiva between the teeth (interdental papilla)
- Peak incidence in young and teenage females
peripheral ossifying fibroma
- Red or pink in color
- Smooth or pebbled irregular surface
- Ulcerated or not
- Broad base attachment, less often pedunculated
peripheral ossifying fibroma
- A highly vascular pedunculated lesion (hanging on stalk)
- Usually on the gingiva of children, young adults, pregnant women (pregnancy tumor)
pyogenic granuloma
- Typically has an ulcerated surface and red to purple color
- Can grow rapidly causing fear of cancer
pyogenic granuloma
- Histologically are highly vascular similar to granulation tissue (chronic inflammatory lesion)
- May develop into a peripheral ossifying fibroma
pyogenic granuloma
-Single or multiple, shallow, hyperemic (red) ulcerations covered by a thin exudate and rimmed by a narrow zone of erythema
apthous ulcer
- 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
apthous ulcer
- Extremely painful and often recurrent
- Spontaneously resolve in 1-2 weeks but may persist for weeks
apthous ulcer
- 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
glossitis
- 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
glossitis
highly resistant to normal bacterial flora
oral mucosa
defenses of oral mucosa
- 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)
Most bacterial infections of the oral mucosa are related to:
- Immunodeficiency (e.g., young, old, pregnant, disease)
- Disruption of the normal flora (e.g., antibiotics)
cytomegalovirus, Epstein-Barr virus (EBV, infectious mononucleosis), varicella-zoster virus, other (130+)
other herpes family viruses
- 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)
viral oral cavity infections
- 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
viral oral cavity infections
-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*
viral oral cavity infections
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
recurrent infection of herpesvirus
- Frequently associated with immunosuppression, e.g., stress, diabetes, concurrent illness
- Usually less severe presentation than primary infection
recurrent infection of herpesvirus
Other viral infections of the oral cavity, head and neck
- enterovirus –> includes Coxackie A and B, Echovirus, other Enterovirus species i.e. hand-foot-and-mouth disease
- rubeola virus –> measles
fungus causing thrush
candida albicans
Superficial infection of mucosal membranes by yeast, may extend into _____ (also found on other mucosal membranes, moist skin areas)
Superficial infection of mucosal membranes by yeast, may extend into esophagus (also found on other mucosal membranes, moist skin areas)
- 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
thrush
Risk increased with immunodeficiency, change in mucosal flora (e.g., after antibiotics)
thrush
____ fungal infections usually have higher morbidity, predilection for the oral cavity and the head and neck region
Deep fungal infections usually have higher morbidity, predilection for the oral cavity and the head and neck region
- Manifested by deep ulcers with or without pseudomembranes, may also involve other tissues of head and neck (or elsewhere)
- Risk higher in immunosuppressed populations
deep fungal infections
Histoplasmosis, Blastomycosis Coccidioidomycosis Cryptococcosis Zygomycosis Aspergillos
deep fungal infections
Scarlet fever, B-vitamin deficiency, iron deficiency, celiac disease, Sjögren syndrome associated with _____ changes
Scarlet fever, B-vitamin deficiency, iron deficiency, celiac disease, Sjögren syndrome associated with tongue changes
Crohn’s disease, celiac disease associated with _____ ______
Crohn’s disease, celiac disease associated with aphthous ulcers
Measles associated with ____ _____
Measles associated with Koplik’s spots
Infectious mononucleosis, diphtheria, streptococcal pharyngitis associated with _________ _______
Infectious mononucleosis, diphtheria, streptococcal pharyngitis associated with pseudomembranous tonsillitis
a white, thickened mucosal patch or plaque, usually with sharply demarcated borders, that cannot be scraped off
leukoplakia
- Caused by hyperplasia of the squamous epithelium, occurs prior to dysplastic and neoplastic transformation
- Also seen in purely inflammatory conditions not associated with malignancy
leukoplakia
- Also seen in purely inflammatory conditions not associated with malignancy
- Associated with human papillomavirus (HPV)
leukoplakia
- Until proved otherwise (histology), all leukoplakias are considered ________
- 1-20% progress to carcinoma within ___ years
- Until proved otherwise (histology), all leukoplakias are considered precancerous
- 1-20% progress to carcinoma within 10 years
red, velvety plaque on epithelial/mucosal surfaces, may be at surrounding height or slightly depressed
erythroplakia
Less common than leukoplakia and higher cancer risk
erythroplakia
Histologically shows intense subepithelial inflammation with vascular dilation, giving the reddish clinical appearance
erythroplakia
Virtually all (approximately 90%) have superficial erosions with dysplasia, carcinoma in situ, or already developed carcinoma
erythroplakia
most common form of head and neck cancers (95%), usually arising in the oral cavity
squamous cell carcinoma
__% of oropharyngeal cancers are associated with HPV
50% of oropharyngeal cancers are associated with HPV
- 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)
squamous cell carcinoma
- 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
squamous cell carcinoma
5-year survival rate of early-stage oral cancer is approximately __%, survival drops to __% for late-stage disease
5-year survival rate of early-stage oral cancer is approximately 80%, survival drops to 19% for late-stage disease
