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
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
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
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
5
Q
squamous cell in the Oral cavity
Overall, ____ have a 5- yr survival rate
A
-57%
6
Q
squamous cell in the Oral cavity
Affects men __ more than women
A
2x
7
Q
what is 90% or all oral cancers
A
squamous cell
8
Q
squamous cell is ________ of all cancer
A
3%
9
Q
Early diagnosis- 40% are found in stage __ or __
A
I or II (80-90% survival)
10
Q
Early diagnosis- 60% found in stages __ or __
A
III or IV
11
Q
if oral cancer is found in the 3rd or 4th stage what is the recurrence?
A
-67% recurrence in 2 years
12
Q
if oral cancer is found in the 3rd or 4th stage what is the survival rate?
A
33%
13
Q
Oral cancer risk factors #1 and #2
A
1 tobacco
#2 alcohol
14
Q
if you elimnated both tobacco and
alcohol this would prevent
A
75% of oral cancer
15
Q
Other oral cancer risk factors
A
viruses (HPV and HIV)
sun exposure
inadequate nutrition
genetic predisposition
chronic inflammation
radiation exposure
carcinogen exposure
16
Q
High- risk areas for oral cancer*
A
-floor of mouth
-lateral border of tongue
-ventral surface of tongue
-oropharynx
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)
18
Q
Bifid uvula: sometimes a bifid uvula is an indication of a __ cleft palate causing __ difficulties
A
submucosa, speech and swallowing
19
Q
Signs and symptoms of oral cancer
A
nonhealing ulcer
hardness
lymphadenopathy
paresthesia
drooling
bleeding
NHL PDB
20
Q
routine oral cancer exam
A
-Question about risk factors
-Examine face (swellings, discolorations, etc)
-Palpate lymph nodes and lips
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
22
Q
Palpation terminology- Bony hard
A
Torus
23
Q
Palpation terminology- Firm but not as hard as bone (solid rubber ball)
A
Induration
24
Q
Palpation terminology- Pressure alters its shape
A
Compressible
25
Palpation terminology- Returns slowly to original shape
Doughy
26
Palpation terminology- Returns quickly to original shape
Spongy
27
Palpation terminology- Soft and leaves indentation- edema
Pitting
28
Palpation terminology- Contents expressed- usually fluid like- abscess
Collapsing
29
Palpation terminology- Color change
Blanching
30
separate, not running together or blending
discrete
31
Running together, merging, blended. Originally separate but now formed into one
confluent
32
having small bump-like elevations or projections
papillary
33
covered with or full of wart-like growths; cauliflower-like surface
Verrucose (aka verrucous) lesion
34
Sessile
-broad base
-firmly attached
-lacks a stalk
35
Pedunculated lesion
**-elevated** lesions
-**e**longated stalk
| pEdunculatEd****
36
Pedunculated lesion can sometimes be
fatal
37
where do Pedunculated lesions occur?
* soft palate
* tonsil
* epiglottis
38
Erythema-
Red area of variable __ and __
Usually in __
Size, shape
Patches
39
Petechia(e)-
Round red pinpoint areas of __
Usually cause by __, __ infection or __ problems
Hemorrhage
Trauma, viral, bleeding
40
Macule
-**<1 cm**,
-**color change**
-black, brown, red, blue
-not elevated or depressed
41
Eschar- a sloughing (shedding) of epithelium caused by
disease, trauma, chemical burn (aspirin burn)
42
an aspirin burn can cause
Eschar
43
bony elevation or prominence known as
Torus
44
Plaque
- solid, flat area
- >1 cm
-**Keratinized** (white)
45
Patch
-large, >1 cm
**-color and texture change**
-not elevated or depressed
46
Ulcer
-**below basal layer**
-usually, painful
-gradual tissue disintegration
47
Papule
-Superficial, <1 cm
-any color
-solid base or pedunculated
48
Vesicle
-small, <1 cm
**-fluid** filled
-lymph or serum
49
Pustule
-small, < 1 cm
-purulent material
**-pus** filled
-creamy white or yellow
50
Nodule
**-elevated**, deep lesion 0.5-2 cm
-**not** fixed
| NOdulE
51
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.
persistent, progressively increases
52
Bulla
-large vesicle, **>1 cm**
**-contains serum**
-mucosal- submucosal junction
53
Linea alba
white line
parallel to occlusal plane
Asymptomatic
Atypical
Caused by trauma
Chewing cheek
54
Leukoedema
“milky” white surface or blue-grey
Symmetrical
**Atypical**
Disappears / decreases when stretched normal
**doesn't rub off**
55
Leukoedema doesn't
RUB OFF
| Disappears / decreases when stretched normal
56
Leukoedema is
* Symmetrical
* Atypical
57
Leukoedema is most commonly seen in
African-Americans
58
Lichen planus
Inflammation of skin and mucous
Interlacing **white striae (wickman)** and erythema
**Bilateral**
Erythematous erosions and ulcers
Purplish, itchy, flat bumps
59
Lichen planus is more common in
women
60
what is seen as a white striae and is bilateral?
Lichen planus
61
Fordyce granules
common
**sulfur colored**
asymptomatic
atypical
1-3 mm papules or lip vermillion
62
what can be sulfur colored that is found in the mouth?
Fordyce granules
63
Torus palatinus and mandibularis
bony lumps
asymptomatic
atypical
no treatment necessary (unless dentures)
64
Nicotine stomatitis
-white
-asymptomatic
-has red dots or macules
-**extreme heat** in mouth
65
where do you find nicotine stomatitis?
on hard palate
66
The most common place for cancer to occur on the tongue is the __ border and the __ of the tongue
lateral, base
67
Atypical findings on the dorsal surface of the tongue are common-fissuring, __, enlarged __ and benign migratory __
scalloping, papilla, glossitis
68
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
different
erythematous
pain, burning
69
Benign migratory glossitis is also called
geographic tongue
70
Leukoplakia-
__ patch like lesion that on mucosa that __ rubbed off
White, cannot
71
Hairy leukoplakia-
Caused by __
Occurs on the __ border of tongue
__ rough patches
epstein- barr virus (HIV or other immunosuppressive conditions)
lateral (unilateral or bilateral)
white
72
Hairy tongue caused by
bacteria
coffee
fungus
antibiotics
tobacco
debris
73
Submandibular duct is also called
Wharton's duct (60% of saliva)
74
xerostomia clinical assessment look for
-Reddened, pebbled surface of tongue
-Dry and cracked corners of the mouth
-Red, glossy, parched mucosal tissues
75
xerostomia clinical assessment test-
mirror "stick" test
place mirror against the buccal mucosa and tongue
76
xerostomia clinical assessment test-
saliva pooling
check for saliva collection on floor of mouth
77
with xerostomia evaluate __ and __
flow, consistency (sore mucosa, burning mouth)
78
xerostomia symptoms-
-Candidiasis
-Angular chelitis
-Root & Cervical caries
-Burning tongue
-Stomatitis
-Dysphagia
| Carbs D
79
describe candidiasis
-white plaque
-creamy white lesions
-buccal mucosa
-lateral boarders of tongue
-dysphagia
80
candidiasis risk factors
-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
candidiasis most common on the
tongue, buccal mucosa, floor
82
candidiasis easily wipe off leaving an
erythematous base
83
candidiasis is also known as
thrush
84
candidiasis pain when eating
spicy or acidic food
85
candidiasis treatment lifestyle
-oral hygiene
-yogurt, **acidophilus**
-avoid alcohol and sugar
86
eating acidophilus food can help to treat
candidiasis
87
candidiasis medication treatment (antifungal)
-nystatin (rinse and tablets)
-ketaconozole (can cause severe liver damage)
88
primary herpes gingivostomatitis is mainly seen in __ and caused by __ in most causes
children, HSV1
89
what is the primary infection of herpes simplex?
primary herpes gingivostomatitis
90
severe primary infection of herpes have oral lesions accompanied by
-high fever
-malaise
-cervical lymphadenopathy
-dehydration
91
herpes gingivostomatitis develops in the oral cavity including
-pharynx
-palate
-buccal mucosa
-lips
-tongue
92
herpes vesicles rapidly breakdown into small ulcers and are covered with an __
exudate
93
with herpes all primary infections occur from contact with
an infected person who is releasing the virus
94
what percent of population has herpes?
50% (starts<10)
| she stated it could be as many as 80%
95
herpes prodromal signs
-tingling, itching, pain, burning
-arise 6-24 hours before lesions develop
96
herpes simplex is __ in nerve cells
dormant
97
herpes simplex recurs with immune weakness such as
-stress
-fever
-illness
-injury
-sunburn
98
primary herpetic gingivostomatitis treated with
**acyclovir** (first 3 symptomatic days, **5x a day for 5 days** rinse)
99
recurrent herpes labialis is best treated in the
prodrome phase
100
medication for herpes
systemic acyclovir, vakacyclovir, famciclovir
101
patients with recurrences of herpes with dental procedures regimen
* **2g** valacyclovir **2x day of**
* **1g 2x following day**
102
3 kinda of aphthous lesions
minor, major, herpetiform
103
apthous ulcers occur in __ of US population
60%
104
apthous ulcers starts are __ age and frequency varies
10-20 years
105
apthous ulcers have what symptoms 1-2 days before appearing?
tingling or burning sensation
106
apthous ulcers __ days pain, __ days healed
3, 7
107
apthous ulcers if mild treated with
topical corticosteroids
108
apthous ulcers appears to be a __ cell mediated immunologic reaction
T
109
if parent has apthous ulcers then __ chance kids will have them
90%
110
minor apthous ulcer __ recurrences and __ duration
fewest, shortest
111
minor apthous ulcers arise almost always on __ and maybe be preceded by __
**nonkeratinized mucosa**, erythematous macule
112
minor apthous ulcers predromal symptoms
burning, itching, stinging
113
minor apthous ulcers size
3- 10 mm
114
What apthous ulcer type is most common?
Minor
115
what apthous ulcer type can scar?
Major
116
what apthous ulcer type has the longest duration?
Major
117
minor apthous ulcers usually __ lesions, and pain __ of proportion for size of ulceration
1-5, out
118
minor apthous ulcers heal without scarring in __ days
7- 14
119
apthous ulcers __ affected most frequently followed by the __ surface of the tongue
buccal and labial mucosa, ventral
120
minor apthous ulcers recurrence rate highly __, ranging from one every few years to __ episodes per month
variable, 2
121
major apthous ulcers have the __ duration per episode
longest
122
major apthous ulcers size
1- 3 cm
123
major apthous ulcers are __ and can take __ weeks to heal
deeper, 2-6
124
major apthous ulcers may cause
scaring
125
what apthous ulcer type on set is after puberty?
Major
126
what apthous ulcer type on set is adulthood?
herpetiform
127
major apthous ulcers lesions vary from
1-10 lesions
128
major apthous ulcers onset is
after puberty
129
herpetiform aphthous ulcerations __ number of lesions and recurrence
GREATEST
130
herpetiform aphthous ulcerations lesion size with as many as __ ulcer present in a single recurrence
100
131
due to herpetiform aphthous ulcerations small size and large number it can resemble
primary HSV infection
132
herpetiform aphthous ulcerations common for individual lesions to coalesce into
larger irregular ulcerations
133
herpetiform aphthous ulcerations heal within __ days, but recurrences tend to be __ spaced
7-10, closely
134
herpetiform aphthous ulcerations many patients affect constantly for periods as long as __
3 years
135
herpetiform aphthous ulcerations __ predominance
female
136
herpetiform aphthous ulcerations affects what mucosa
any oral mucosa
137
all canker sores major differences
minor-
<1 cm and shallow
major-
>1 cm and deeper
-may scar
herperiform-
-more numerous and vesicular
138
herpetiform aphthous ulcerations onset
adulthood
139
aphthous ulcers treatment for symptomatic patients
-viscous benzocaine
-orajel, anbesol
140
aphthous ulcers treatment local anti inflammatory
kenalog in orabase paste 2-4x a day
141
aphthous ulcers treatment can use a sealing agent such as
ameseal
142
aphthous ulcers treatment only FDA approved treatment
-aphthasol
-paste= barrier
-apply 2-4x/day
-must start early (prodromal stage)
143
surface lesions do not exceed
2-3mm in thickness
144
hair tongue is a result of accumulation of
keratin on the dorsal surface of the tongue
145
what causes hairy leukplakia
epstein-barr virus
146
what can happen when dentures don't fit properly?
atrophic candidiasis
147
