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Patient care II > Intraoral examination > Flashcards

Intraoral examination Flashcards

1
Q

We continue to see an increase of oral cancer diagnoses in patients under the age of __ with no known risk factors; __ __ included in this age group is a significant increase in cancer of the tongue

A

40, HPV 16

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2
Q

Current research implicates the human papillomavirus (HPV) as the underlying cause of as many as __ of oropharyngeal squamous cell carcinomas with a predominate increase seen in younger __ men

A

72%, white

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3
Q

Oral cancer- A biopsy involving the removal of part or all of the suspicious area of tissue and microscopic evaluation by a pathologist to determine its histological makeup is the __ __ for determining a definitive diagnosis

A

Gold standard

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4
Q

A study by Kondori,et al. in 2011 reported a high rate (43%) of misdiagnosis of oral lesions by dental practitioners when they based their diagnosis on __

A

Clinical observations alone

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5
Q

squamous cell in the Oral cavity
Overall, ____ have a 5- yr survival rate

A

-57%

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6
Q

squamous cell in the Oral cavity

Affects men __ more than women

A

2x

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7
Q

what is 90% or all oral cancers

A

squamous cell

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8
Q

squamous cell is ________ of all cancer

A

3%

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9
Q

Early diagnosis- 40% are found in stage __ or __

A

I or II (80-90% survival)

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10
Q

Early diagnosis- 60% found in stages __ or __

A

III or IV

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11
Q

if oral cancer is found in the 3rd or 4th stage what is the recurrence?

A

-67% recurrence in 2 years

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12
Q

if oral cancer is found in the 3rd or 4th stage what is the survival rate?

A

33%

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13
Q

Oral cancer risk factors #1 and #2

A

1 tobacco

#2 alcohol

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14
Q

if you elimnated both tobacco and
alcohol this would prevent

A

75% of oral cancer

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15
Q

Other oral cancer risk factors

A

viruses (HPV and HIV)
sun exposure
inadequate nutrition
genetic predisposition
chronic inflammation
radiation exposure
carcinogen exposure

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16
Q

High- risk areas for oral cancer*

A

-floor of mouth
-lateral border of tongue
-ventral surface of tongue
-oropharynx

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17
Q

Occasionally, individuals have large crypts in the tonsils that collect food debris, bacteria and hardened material ( tonsil stones) known as

A

Tonsillar crypt (complain of halitosis aka bad breath)

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18
Q

Bifid uvula: sometimes a bifid uvula is an indication of a __ cleft palate causing __ difficulties

A

submucosa, speech and swallowing

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19
Q

Signs and symptoms of oral cancer

A

nonhealing ulcer
hardness
lymphadenopathy
paresthesia
drooling
bleeding

NHL PDB

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20
Q

routine oral cancer exam

A

-Question about risk factors
-Examine face (swellings, discolorations, etc)
-Palpate lymph nodes and lips

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21
Q

Routine Oral Cancer Exam (con’t)

A

-Palpate labial and buccal mucosa
-Examine and bimanually* palpate floor of mouth
-Examine palpate tongue
-Exam hard and soft palate
-Examine tonsils and oropharynx

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22
Q

Palpation terminology- Bony hard

A

Torus

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23
Q

Palpation terminology- Firm but not as hard as bone (solid rubber ball)

A

Induration

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24
Q

Palpation terminology- Pressure alters its shape

A

Compressible

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25
Q

Palpation terminology- Returns slowly to original shape

A

Doughy

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26
Q

Palpation terminology- Returns quickly to original shape

A

Spongy

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27
Q

Palpation terminology- Soft and leaves indentation- edema

A

Pitting

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28
Q

Palpation terminology- Contents expressed- usually fluid like- abscess

A

Collapsing

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29
Q

Palpation terminology- Color change

A

Blanching

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30
Q

separate, not running together or blending

A

discrete

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31
Q

Running together, merging, blended. Originally separate but now formed into one

A

confluent

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32
Q

having small bump-like elevations or projections

A

papillary

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33
Q

covered with or full of wart-like growths; cauliflower-like surface

A

Verrucose (aka verrucous) lesion

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34
Q

Sessile

A

-broad base
-firmly attached
-lacks a stalk

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35
Q

Pedunculated lesion

A

-elevated lesions
-elongated stalk

pEdunculatEd**

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36
Q

Pedunculated lesion can sometimes be

A

fatal

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37
Q

where do Pedunculated lesions occur?

A
  • soft palate
  • tonsil
  • epiglottis
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38
Q

Erythema-
Red area of variable __ and __
Usually in __

A

Size, shape
Patches

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39
Q

Petechia(e)-
Round red pinpoint areas of __
Usually cause by __, __ infection or __ problems

A

Hemorrhage
Trauma, viral, bleeding

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40
Q

Macule

A

-<1 cm,
-color change
-black, brown, red, blue
-not elevated or depressed

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41
Q

Eschar- a sloughing (shedding) of epithelium caused by

A

disease, trauma, chemical burn (aspirin burn)

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42
Q

an aspirin burn can cause

A

Eschar

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43
Q

bony elevation or prominence known as

A

Torus

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44
Q

Plaque

A
  • solid, flat area
  • > 1 cm
    -Keratinized (white)
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45
Q

Patch

A

-large, >1 cm
-color and texture change
-not elevated or depressed

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46
Q

Ulcer

A

-below basal layer
-usually, painful
-gradual tissue disintegration

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47
Q

Papule

A

-Superficial, <1 cm
-any color
-solid base or pedunculated

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48
Q

Vesicle

A

-small, <1 cm
-fluid filled
-lymph or serum

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49
Q

Pustule

A

-small, < 1 cm
-purulent material
-pus filled
-creamy white or yellow

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50
Q

Nodule

A

-elevated, deep lesion 0.5-2 cm
-not fixed

NOdulE

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51
Q

Irritation Fibroma-
Is classified as a tumor because this lesion is __ and __ __ in size. Although most people agree the true pathogenesis is that of a reactive process secondary to chronic irritation.

A

persistent, progressively increases

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52
Q

Bulla

A

-large vesicle, >1 cm
-contains serum
-mucosal- submucosal junction

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53
Q

Linea alba

A

white line
parallel to occlusal plane
Asymptomatic
Atypical
Caused by trauma
Chewing cheek

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54
Q

Leukoedema

A

“milky” white surface or blue-grey
Symmetrical
Atypical
Disappears / decreases when stretched normal
doesn’t rub off

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55
Q

Leukoedema doesn’t

A

RUB OFF

Disappears / decreases when stretched normal

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56
Q

Leukoedema is

A
  • Symmetrical
  • Atypical
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57
Q

Leukoedema is most commonly seen in

A

African-Americans

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58
Q

Lichen planus

A

Inflammation of skin and mucous
Interlacing white striae (wickman) and erythema
Bilateral
Erythematous erosions and ulcers
Purplish, itchy, flat bumps

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59
Q

Lichen planus is more common in

A

women

60
Q

what is seen as a white striae and is bilateral?

A

Lichen planus

61
Q

Fordyce granules

A

common
sulfur colored
asymptomatic
atypical
1-3 mm papules or lip vermillion

62
Q

what can be sulfur colored that is found in the mouth?

A

Fordyce granules

63
Q

Torus palatinus and mandibularis

A

bony lumps
asymptomatic
atypical
no treatment necessary (unless dentures)

64
Q

Nicotine stomatitis

A

-white
-asymptomatic
-has red dots or macules
-extreme heat in mouth

65
Q

where do you find nicotine stomatitis?

A

on hard palate

66
Q

The most common place for cancer to occur on the tongue is the __ border and the __ of the tongue

A

lateral, base

67
Q

Atypical findings on the dorsal surface of the tongue are common-fissuring, __, enlarged __ and benign migratory __

A

scalloping, papilla, glossitis

68
Q

Benign migratory glossitis-
Lesions often heal in one area and then move to a __ part of the tongue

__, well demarcated areas of papillary atrophy
Usually asymptomatic but can cause __ or __ when eating acidic or spicy foods

A

different

erythematous
pain, burning

69
Q

Benign migratory glossitis is also called

A

geographic tongue

70
Q

Leukoplakia-
__ patch like lesion that on mucosa that __ rubbed off

A

White, cannot

71
Q

Hairy leukoplakia-
Caused by __
Occurs on the __ border of tongue
__ rough patches

A

epstein- barr virus (HIV or other immunosuppressive conditions)
lateral (unilateral or bilateral)
white

72
Q

Hairy tongue caused by

A

bacteria
coffee
fungus
antibiotics
tobacco
debris

73
Q

Submandibular duct is also called

A

Wharton’s duct (60% of saliva)

74
Q

xerostomia clinical assessment look for

A

-Reddened, pebbled surface of tongue
-Dry and cracked corners of the mouth
-Red, glossy, parched mucosal tissues

75
Q

xerostomia clinical assessment test-
mirror “stick” test

A

place mirror against the buccal mucosa and tongue

76
Q

xerostomia clinical assessment test-
saliva pooling

A

check for saliva collection on floor of mouth

77
Q

with xerostomia evaluate __ and __

A

flow, consistency (sore mucosa, burning mouth)

78
Q

xerostomia symptoms-

A

-Candidiasis
-Angular chelitis
-Root & Cervical caries
-Burning tongue
-Stomatitis
-Dysphagia

Carbs D

79
Q

describe candidiasis

A

-white plaque
-creamy white lesions
-buccal mucosa
-lateral boarders of tongue
-dysphagia

80
Q

candidiasis risk factors

A

-birth control pills
-pregnancy
-poor oral hygiene
-immunocompromised
-long term AB
-smoking
-stress
-depression
-diabetes
-dentures that don’t fit (atrophic candidiasis)
-xerostomia
-iron, B12 deficiency

81
Q

candidiasis most common on the

A

tongue, buccal mucosa, floor

82
Q

candidiasis easily wipe off leaving an

A

erythematous base

83
Q

candidiasis is also known as

A

thrush

84
Q

candidiasis pain when eating

A

spicy or acidic food

85
Q

candidiasis treatment lifestyle

A

-oral hygiene
-yogurt, acidophilus
-avoid alcohol and sugar

86
Q

eating acidophilus food can help to treat

A

candidiasis

87
Q

candidiasis medication treatment (antifungal)

A

-nystatin (rinse and tablets)
-ketaconozole (can cause severe liver damage)

88
Q

primary herpes gingivostomatitis is mainly seen in __ and caused by __ in most causes

A

children, HSV1

89
Q

what is the primary infection of herpes simplex?

A

primary herpes gingivostomatitis

90
Q

severe primary infection of herpes have oral lesions accompanied by

A

-high fever
-malaise
-cervical lymphadenopathy
-dehydration

91
Q

herpes gingivostomatitis develops in the oral cavity including

A

-pharynx
-palate
-buccal mucosa
-lips
-tongue

92
Q

herpes vesicles rapidly breakdown into small ulcers and are covered with an __

A

exudate

93
Q

with herpes all primary infections occur from contact with

A

an infected person who is releasing the virus

94
Q

what percent of population has herpes?

A

50% (starts<10)

she stated it could be as many as 80%

95
Q

herpes prodromal signs

A

-tingling, itching, pain, burning
-arise 6-24 hours before lesions develop

96
Q

herpes simplex is __ in nerve cells

A

dormant

97
Q

herpes simplex recurs with immune weakness such as

A

-stress
-fever
-illness
-injury
-sunburn

98
Q

primary herpetic gingivostomatitis treated with

A

acyclovir (first 3 symptomatic days, 5x a day for 5 days rinse)

99
Q

recurrent herpes labialis is best treated in the

A

prodrome phase

100
Q

medication for herpes

A

systemic acyclovir, vakacyclovir, famciclovir

101
Q

patients with recurrences of herpes with dental procedures regimen

A
  • 2g valacyclovir 2x day of
  • 1g 2x following day
102
Q

3 kinda of aphthous lesions

A

minor, major, herpetiform

103
Q

apthous ulcers occur in __ of US population

A

60%

104
Q

apthous ulcers starts are __ age and frequency varies

A

10-20 years

105
Q

apthous ulcers have what symptoms 1-2 days before appearing?

A

tingling or burning sensation

106
Q

apthous ulcers __ days pain, __ days healed

A

3, 7

107
Q

apthous ulcers if mild treated with

A

topical corticosteroids

108
Q

apthous ulcers appears to be a __ cell mediated immunologic reaction

A

T

109
Q

if parent has apthous ulcers then __ chance kids will have them

A

90%

110
Q

minor apthous ulcer __ recurrences and __ duration

A

fewest, shortest

111
Q

minor apthous ulcers arise almost always on __ and maybe be preceded by __

A

nonkeratinized mucosa, erythematous macule

112
Q

minor apthous ulcers predromal symptoms

A

burning, itching, stinging

113
Q

minor apthous ulcers size

A

3- 10 mm

114
Q

What apthous ulcer type is most common?

A

Minor

115
Q

what apthous ulcer type can scar?

A

Major

116
Q

what apthous ulcer type has the longest duration?

A

Major

117
Q

minor apthous ulcers usually __ lesions, and pain __ of proportion for size of ulceration

A

1-5, out

118
Q

minor apthous ulcers heal without scarring in __ days

A

7- 14

119
Q

apthous ulcers __ affected most frequently followed by the __ surface of the tongue

A

buccal and labial mucosa, ventral

120
Q

minor apthous ulcers recurrence rate highly __, ranging from one every few years to __ episodes per month

A

variable, 2

121
Q

major apthous ulcers have the __ duration per episode

A

longest

122
Q

major apthous ulcers size

A

1- 3 cm

123
Q

major apthous ulcers are __ and can take __ weeks to heal

A

deeper, 2-6

124
Q

major apthous ulcers may cause

A

scaring

125
Q

what apthous ulcer type on set is after puberty?

A

Major

126
Q

what apthous ulcer type on set is adulthood?

A

herpetiform

127
Q

major apthous ulcers lesions vary from

A

1-10 lesions

128
Q

major apthous ulcers onset is

A

after puberty

129
Q

herpetiform aphthous ulcerations __ number of lesions and recurrence

A

GREATEST

130
Q

herpetiform aphthous ulcerations lesion size with as many as __ ulcer present in a single recurrence

A

100

131
Q

due to herpetiform aphthous ulcerations small size and large number it can resemble

A

primary HSV infection

132
Q

herpetiform aphthous ulcerations common for individual lesions to coalesce into

A

larger irregular ulcerations

133
Q

herpetiform aphthous ulcerations heal within __ days, but recurrences tend to be __ spaced

A

7-10, closely

134
Q

herpetiform aphthous ulcerations many patients affect constantly for periods as long as __

A

3 years

135
Q

herpetiform aphthous ulcerations __ predominance

A

female

136
Q

herpetiform aphthous ulcerations affects what mucosa

A

any oral mucosa

137
Q

all canker sores major differences

A

minor-
<1 cm and shallow
major-
>1 cm and deeper
-may scar
herperiform-
-more numerous and vesicular

138
Q

herpetiform aphthous ulcerations onset

A

adulthood

139
Q

aphthous ulcers treatment for symptomatic patients

A

-viscous benzocaine
-orajel, anbesol

140
Q

aphthous ulcers treatment local anti inflammatory

A

kenalog in orabase paste 2-4x a day

141
Q

aphthous ulcers treatment can use a sealing agent such as

A

ameseal

142
Q

aphthous ulcers treatment only FDA approved treatment

A

-aphthasol
-paste= barrier
-apply 2-4x/day
-must start early (prodromal stage)

143
Q

surface lesions do not exceed

A

2-3mm in thickness

144
Q

hair tongue is a result of accumulation of

A

keratin on the dorsal surface of the tongue

145
Q

what causes hairy leukplakia

A

epstein-barr virus

146
Q

what can happen when dentures don’t fit properly?

A

atrophic candidiasis

147
Q
A

Patient care II (12 decks)

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