Goljan 18: Oral Cavity and Salivary Glands

Question 1

What are the oral manifestations of HIV?

Answer 1

1. Candidiasis 2. Aphthous ulcers 3. Hairy leukoplakia - glossitis due to EBV 4. Kaposi sarcoma - HHV8

Question 2

Dental caries are most often caused by:

Answer 2

Strep mutans Prevention is fluoride

Question 3

What is the diagnosis? Notched teeth

Answer 3

Congenital syphilis Treponma Palladium Incisors are notched and tapered like pegs, molars look like mulberries

Question 4

What is the diagnosis? Glossitis associated with bilateral white excrescences on lateral border of tongue

Answer 4

Hairy leukoplakia Pre-AIDS defining lesion

Question 5

What is the diagnosis? Recurrent vesicular lesions on the lips, reactivated by stress, sunlight, menses

Answer 5

Herpes labialis HSV-1 (usually)

Question 6

What is the diagnosis? Bilateral parotitis with increased serum amylase; Complications include meningoencephalitis, unilateral orchitis or oophoritis and pancreatitis

Answer 6

Mumps (paroxymyxovirus)

Question 7

What is the diagnosis? Painful vesicles or small white papules occur on an erythematous base typically at the junction of the soft and hard palate

Answer 7

Herpangina due to coxackievirus When vesicles located in mouth and distal extremities, it’s hand, foot and mouth disease

Question 8

What is the diagnosis? “Sulfur granules” in pus contain gram + branching filamentous anaerobic bacteria ; often follows extraction of an abscessed tooth

Answer 8

Cervicofacial actinomycosis Actinomyces israelii

Question 9

What is the diagnosis? Shaggy gray pseudomembrane in posterior pharynx and upper airways

Answer 9

Diphtheria Corynebacterium diphtheriae

Question 10

Peritonsillar abscess can be a complication of:

Answer 10

Tonsillitis (strep pyogenes) uvula deviates from contralateral side; “hot potato” voice foul-smelling breath

Question 11

What is the diagnosis? Cellulitis involving the submaxillary and sublingual space

Answer 11

Ludwig Angina follows facial planes due to aerobic or anaerobic strep eikenella or corrodens causes are trauma or dental work

Question 12

T/F: Nephritogenic strains of Strep pyogenes pose no risk for acute rheumatic fever

Answer 12

True

Question 13

What is the diagnosis? Necrosis of interdental papilla with punched out lesions covered by grayish pseudomembrane

Answer 13

Acute necrotizing gingivitis Anaerobic bacterial infection of the gingiva

Question 14

What is the diagnosis? Hypersensitivity reaction against mycoplasma or sulfa drugs

Answer 14

Erythema multiforme called Stevens-Johnson syndrome when it involves the mouth

Question 15

What is the diagnosis? Melanin pigmentation of the lips and oral mucosa

Answer 15

Peutz-Jeghers syndrome could also be Addison disease (on buccal mucosa) could also be lead poisoning

Question 16

When tooth discoloration occurs in children as a result of medication, what is the implicated medication?

Answer 16

Tetracycline When tooth discoloration is not due to tetracycline, it is usually excess fluoride (chalky white) OR could be congenital erythropoetic porphyria (reddish brown)

Question 17

Myxedema Down syndrome Acromegaly Systemic amyloidosis Mucosal neuromas in multiple endocrine neoplasia syndrome IIb These are all causes of what oral finding?

Answer 17

Macroglossia (enlarged tongue)

Question 18

What is the diagnosis? Sore, beefy, red tongue with or without papillary atrophy

Answer 18

Glossitis (inflammation of the tongue) Causes include: long-standing iron deficiency B12 or folate deficiency Scurvy Pellagra (niacin deficiency) Scarlet fever EBV-associated hairy leukoplakia

Question 19

What is the diagnosis? Vermilion border on the lower lip

Answer 19

Leuko/erythroplakia

Question 20

What is the diagnosis? Wickham striae on the buccal mucosa (fine white lacey lesions)

Answer 20

Lichen planus May be associated with SCC or dysplasia

Question 21

What is an ameloblastoma?

Answer 21

Benign tumor of the epithelium Arises from enamel organ epithelium or a dentigerous cyst; Located in the mandible –> “soap bubble” appearance; Locally invasive but does not metastasize

Question 22

What is the diagnosis? Most common benign tumor in the oral cavity; Exophytic tumor with a fibrovascular core May occur on the tongue, gingiva, palate, or lips

Answer 22

Squamous papilloma

Question 23

What kind of cancer is associated with chew tobacco?

Answer 23

Verrucous carcinoma of the oral cavity

Question 24

Malignancy of the oral cavity typically metastasizes to what lymph node?

Answer 24

Tonsillar node (superior jugular node)

Question 25

What is the diagnosis? Most common cancer of the upper lip Associated with UVB exposure

Answer 25

Basal cell carcinoma

Question 26

What is the diagnosis? Autoimmune destruction of the salivary glands and lacrimal glands

Answer 26

Sjogren syndrome

Question 27

What is the diagnosis? Women; painless movable mass at the angle of the jaw; may become malignant epithelial cells intermixed with myxomatous and cartilaginous stroma

Answer 27

Pleomorphic adenoma

Question 28

What is the diagnosis? Men; Benign parotid gland tumor; Smokers at increased risk; Heterotropic salivary gland tissue is trapped in a lymph node

Answer 28

Warthin tumor (papillary cystadenoma lymphomatosum)

Question 29

What is the diagnosis? Most common malignant salivary gland tumor; Most commonly in the parotid gland; Mixture of neoplastic squamous and mucus-secreting cells

Answer 29

Mucoepidermoid carcinoma