Fundamentals of Oral Disease Flashcards
Primary factors contributing to oral disease
6
- Smoking
- Etoh (including mouth wash)
- Systemic disease
- Medications (dexamethasone can be prone to getting candida infections)
- Stress/hormonal changes
- Genetics (some individuals are more prone to oral lesions/dz)
What systemic diseases can contribute to oral disease?
5
- Infections
- Diabetes (immunocompromised) ~ thrush due to hyperglycemic levels which promote environment for yeast to grow.
- Anemia
- Bowel disease
- Autoimmune Disease (Bechet’s)
What is Oral Frictional Hyperkeratosis?
excessive growth of stubbornly attached keratin (a fibrous protein produced by the body)
Causes of Oral Frictional Hyperkeratosis?
4
may happen for a number of reasons and
1. may be genetic
(runs in the family),
2. physiological (normal bodily response to
certain stimuli),
3. pre-cancerous and cancerous. The change
may result from
4. chemical, heat or physical irritants.
USUALLY NONINFECTIOUS
Why should we always refer Oral Frictional Hyperkeratosis?
You should refer this to R/O malignancy and ensure it is benign.
Oral Disease Groupings
6
- “Local” infections
- Mucosal dermatologic changes
- Halitosis
- Pharmaceutical-induced changes
- Systemic disease manifestations
- Dental trauma
“Local” Infections
9
- Dental caries/acute pulpitis
- Gingivitis/periodontitis
- Dental abscesses
- Necrotizing periodontal disease (Vincent’s angina)
- Ludwig’s angina
- “Fever blister” or “Cold Sores”
- Herpangina
- Thrush
- Hairy tongue
Dental caries/acute pulpitis
- Cause?
- Pathophysiology? 2
- Symptoms? 2
- Cause: Streptococcus mutans and other bacteria
- Pathophysiology:
- Destoys hard tissues of teeth
- Progresses into dental pulp (acute pulpitis) - Sx:
- Hot/cold sensitivity
- Continuous throbbing pain (later)
Dental caries/acute pulpitis
- Prevention? 5
- Tx? 2
- High risk populations? 3
- Prevention:
- Fluoride,
- brushing,
- flossing,
- mouthwashes
- routine cleanings - Tx:
- Simple caries: restoration
- Pulpitis: antibiotics and NSAIDs; root canal may be necessary - High Risk Populations:
- Chemotherapy
- Diabetics
- Xerostomia secondary to other causes
What is Gingivitis?
2
- Inflammation of marginal gingiva (gums)
2. Earliest form of periodontal disease
Etiology of Gingivitis?
Clinical presentation of Gingivitis?
3
Treatment?
Etiology:
1. Anaerobes (cause of halitosis) most common cause
Clinical:
- Usually painless
- Increased bleeding with brushing
- Soft tissue separation (“pocket” formation)
In a non-allergy pt, penicillin/amoxicillin has great coverage against anaerobes/Clindamycin as alternative
Dental (periodontal) abscess
- PP?
- Clinical presentation? 4
- Treatment? 2
- Prevention?
- Pathophysiology:
Gingival soft tissue inflammation/infection - Clinical:
- Edema,
- erythema,
- pyorrhea,
- pain - Treatment:
- Oral antibiotic (penicillin or clindamycin)
- NSAID (prn) - Prevention:
- Good oral hygiene (brushing, flossing, antibacterial mouth rinses, removal of impacted food debris, routine visits to dental hygienist)
Acute necrotizing ulcerative gingivitis
- AKA?
- Signs/Sx? 2
- Tx? 2
- Vincent’s angina (Trench mouth)
- Signs/Sx:
- Halitosis
- Ulcerations of the interdental papillae - Tx:
- Penicillin (PO) + metronidazole
- Clindamycin (alone)
- Acute necrotizing ulcerative gingivitis is strongly associated with what?
- How does it differ from gingivitis?
- Strongly associated with HIV infection but not pathognomonic
- Differs from gingivitis as this is more necrotic and much more serious.
Ludwig’s angina
- PP? 2
- Signs/Sx? 3
- Tx covers what? 2
- Tx? 2
- Pathophysiology
- Rapidly spreading cellulitis of sublingual (SL) and submandibular spaces
- Usually begins as infected lower molar - Signs/Sx:
- Febrile
- Drooling/trismus
- Edema in SL area spreading down neck - Tx:
IV antibiotics covering streptococcus and oral anaerobes - Penicillin or ampicillin/sulbactam (unasyn) combination of a beta lactam and a beta lactam inhibitor
- Plus metronidazole (Flagyl) ~ 500mg PO tid (metallic taste in their mouth)
Herpatic Leisons
- Presentation? 2
- Etiology? 1
- Lesions? 5
- Treatments? 3
- Presentation:
- Cold sores (“fever blisters”) or
- painful vesicles on tongue/buccal mucosa - Etiology:
- HSV-1 (or HSV-2) - Lesions:
- Vesicles
- White coated tongue
- Ulcerative gingivitis
- Lip lesions
- Facial lesions - Treatments:
- Acyclovir (Zovirax) 400mg 5x/d
- Valacyclovir (Valtrex) 1000tid
- Valtrex is prophylaxis
Herpangina
- Etiology?
- Clinical features?
- How long does it last?
- Tx?
- Etiology: Picornovirus (not Herpes) called coxsackie virus
- Clinical features:
-PAINFUL, fever, malaise, sore throat
-Vesicles are present on the soft palate - 7-10 days
- Tx:
Supportive (analgesics)
Herpangina complications can lead to what?
dilated cardiomyopathy from the coxsackie virus.
Oral candidiasis (Thrush)
- Etiology?
- Occurrence? 3
- Signs/Sx?
- Treatment? 2
- Etiology: Candida sp.
- Occurrence:
- neonates;
- prolonged antibiotic use;
- immunocompromised patients - Signs/Sx:
- white plaques on tongue/oral mucosa; “burning” tongue; “raw” throat - Treatment:
- Topical antifungals: clotrimazole (Mycelex) troches or nystatin (swish & spit/swallow)
- Oral fluconazole (Diflucan) ~ used w/ recurrent candidiasis. 200mg one dose and 100mg for 7 days.
- What is hairy tongue?
2. What is the coloration?
- Elongation of filiform papillae of dorsal surface
2. Coloration due to staining (by tobacco or food) or infection with chromogenic organisms (commonly fungi)
Mucosal Dermatologic Changes
4
- Aphthous stomatitis (ulcers) ~ canker sores
- Geographic tongue
- Oral leukoplakia
- Oral cancer
Most common oral ulceration, seen in 10-20% of the population
Aphthous stomatitis (ulcers)
Aphthous stomatitis (ulcers)
1. Etiologies?
5
- Thought to be an auto-immune process but with numerous etiologies
- CMV (cytomegalovirus which is ubiquitous in about 50% of population)
- Hormones
- Nutritional deficiency (vit B def)
- Some studies report predilection for females
- Hormonal changes
- Common ages are puberty through age 22
Aphthous stomatitis (ulcers)
- Lasts how long?
- Management? 7
- Last 7-10 days.
- Management
- Sucralfate (Carafate)
- Acidophilus
- Folate
- Vitamin B12
- Stress relief
- Licorice
- Corticosteroids (dexamethasone or temovate or lidex)
What is Geographic tongue? 2
- Asymptomatic inflammatory condition
2. Rapid loss and regrowth of filiform papillae causes denuded red patches to “wander” across the surface of the tongue
Oral leukoplakia
- PP? 2
- Clinical presentation?
- Treatment?
- Pathophysiology:
- Benign epithelial hyperplasia
- Strongly associated with HIV infection - Clinical:
Asymptomatic lesions usually lateral surfaces of tongue (rarely elsewhere) - Treatment:
Responds to high dose acyclovir (Zovirax)
Oral cancer
- Etiologies? 2
- Detection?
- Etiology:
- TOBACCO / ETOH USE
- HPV - Detection:
- All ulcerative oral lesions which fail to heal within 2 weeks should be biopsied
Drug-Induced Oral Pathology
-Most pharmaceuticals have oral side effects
4
- Xerostomia (antihistamines)
- Pigmentation changes
- Hyperplasia
- Mucositis
Causes of Halitosis?
7
- Bronchiectasis
- Smokers/alcoholics
- Fetor hepatis: fishy odor
- Azotemia
- Diabetes
- H. Pylori
- metal poisoning
Xerostomia
- Pharmacologic causes? 2
- Clinical presentation?
- Treatment? 2
- -Diuretics
-Drugs with anticholinergic effect
(Antihistamines)
(Tricyclic antidepressants (not often used for antidepressants. Now used more for neuropathy (neuropathic pain) and sleep) - C/O oral dryness, burning of the tissues, difficulty eating and swallowing, tongue irritation, painful ulcerations, progressively increasing caries and periodontal disease
- Saliva substitutes
- Salivary stimulation with sugarless hard candies
Describe the pigment changes that each of the following cause:
- Tetracycline?
- Sedatives, OCP, Antimalarials?
- Amalgam tattoo?
- Heavy metal pigmentation (bismuth, mercury, lead)?
- Causes permanent discoloration of teeth and enemel hypoplasia if given during 2nd half of pregnancy or to children from infancy thru age 8
- Brown, black or gray areas of oral mucosa pigmentation (disappears following drug cessation)
- Blue-black pigmentation in the gingival and mucobuccal fold area
- Thin blue-black pigmented line along gingival margin
What medications can cause gingival hyperplasia?
3
Treatment?
- Phenytoin (Dilantin) (~40% of those treated)
- Calcium channel blockers (nifedipine)
- Cyclosporin
Surgical removal of tissue is effective but hyperplasia recurs if drug is discontinued
Mucositis
- Etiology? 2
- Clinical presentation? 2
- Etiology
- NUMEROUS chemotherapeutic agents
- Radiation therapy to head and neck cancers - Clinical:
- Edema
- painful chewing/swallowing of food
Systemic disease manifestations
7
- Diabetes
- Anemia
- Vitamin deficiency
- Mononucleosis
- HIV/AIDS
- Cancer
- Bechet’s Disease
Oral problems with diabetes?
7
Treatment and prevention?
- Acute gingival (periodontal) abscesses
- Gingival proliferations/red-gingival hypertrophy
- Dry burning mouth
- Gingival tenderness/spontaneous bleeding
- Lip dryness
- Tooth mobility
- Periodontal disease
Tight glycemic control
Pernicious anemia (vitamin B12 deficiency) can cause what?
Glossitis: Smooth, beefy-red and sore (tender) tongue
Iron deficiency anemia can cause what?
2
- Glossitis: Reddened, edematous, smooth, shiny and tender tongue
- Angular cheilitis/stomatitis: Erosion, tenderness and edema at corners of the mouth
Vitamin Deficiency can cause what?
6
- Oral mucositis
- Ulcers
- Glossitis and burning sensations in the tongue (glossodynia) (common with B group deficiencies)
- Petechiae
- Gingival swelling and bleeding
- Teeth loosening and ulcerations (common in vitamin C deficiencies)
Mononucleosis oral manifestations?
4
- Palatal (hard palate) petechiae
- Pharyngitis (with or without exudate)
- Lethargy
- Sore throat
AIDS/HIV Infections
HIV immunosuppression predisposes patients to what?
5
- Oral candidiasis
- Necrotizing ulcerative periodontal disease (Vincent’s angina)
- Stomatitis (enterics)
- Hairy leukoplakia
- AIDS pathognomonic oral lesions
- Oral Kaposi’s sarcoma
- Oral lymphoma
Cancer: Acute Leukemias (especially monocytic) will present how?
5
- Gingival bleeding,
- necrotic ulcers,
- gingival enlargement/hyperplasia due to massive infiltration of leukemic cells
- Bluish gingival appearance
- Oral infections and marked discomfort
Radiation therapy for head and neck cancer can cause what oral manifestations?4
Labs? 2
- Severe oral mucositis with ulcers,
- candidiasis,
- bacterial infections and
- xerostomia
check platelets and coags to R/O cancer as it can be associated with leukemias.
- Cheilosis (cheilitis) is what?
- Presentation?
- Etiology? 4
- Management
- Inflammation and small cracks in one or both corners of the mouth.
- Presentation
- Inflammation and/or fissuring of the lips - Etiology
- Environmental irritation (chapping)
- Metabolic/Nutritional (diabetes, anemia, thyroid disease, vitamin deficiencies)
- Poor fitting dentures
- Infection - Management
Eliminate cause
- Sialoadenitis is what?
- Usually occur where?
- Often seen in what kind of pts? 3
- Obstruction results in what?
- Infections of salivary glands may be viral (mumps) or bacterial (usually secondary to obstruction)
- Salivary stones (sialolithiasis) usually occur in the major duct of the salivary gland
- Often seen in
- elderly,
- debilitated or
- post-op patients who become dehydrated - Obstruction results in inflammation/infections of salivary glands (sialoadenitis)
Clinical presentation of sialoadenitis?
3
- Edema,
- pain (worse with eating, especially tart foods like lemons)
- Purulent drainage may be obtained from duct orifice
TMJ Dysfunction
- What gender?
- Describe the pain? 6
- Difficulty with what?
- What kind of sensation on the tongue?
- Complications? 3
- Pain/tenderness where?
- Usually adult female patients
- Unilateral pain
- dull, aching,
- worsening throughout the day
- in region of jaw,
- joint “popping” or crepitus,
- acute otalgia
- Difficulty chewing or opening mouth widely
- Burning sensation of tongue or palate
- -Bruxism (teeth grinding),
-tinnitus,
-vertigo
leads to chgs in bite, height of teeth, etc. - Acute tenderness over TMJ
TMJ management?
3
- Physiotherapy: warm moist compresses 15 min qid for 7-10 days
- Pureed diet 1-2 weeks
- Analgesics and muscle relaxants
