Intraoral Exams Flashcards by Michael McMahan

Where is the type 2 Herpe simplex fever blisters located?

genital

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• VESICLES DEVELOP IN THE ORAL CAVITY, INCLUDING
THE PHARYNX, PALATE, BUCCAL MUCOSA, LIPS, AND/OR
TONGUE.
• THE VESICLES RAPIDLY BREAK DOWN INTO SMALL
ULCERS AND ARE COVERED WITH AN EXUDATE
• LESIONS MAY EXTEND TO INVOLVE THE LIPS AND
BUCCAL MUCOSA.
• THE LESIONS GENERALLLY RESOLVE WITHOUT
THERAPY IN TWO WEEKS

HERPES GINGIVOSTOMATITIS

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Common for individual lesions to coalesce into larger irregular ulcerations.
Heal within 7-10 days, but the recurrences tend to be closely spaced.
Many patients are affected almost constantly for periods as long as 3 years.
Any oral mucosal may be involved
Female predominance
Onset is adulthood.

HERPETIFORM APHTHOUS ULCERATIONS

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What is the difference between Minor and Major Canker sores

Minor: <1 cm and shallow

Major > 1 cm and deeper

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Which is the only FDA approved treatment for canker sores? What is significant about it.

Aphthasol

must be started early in the prodromal stage.

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

CONFLUENT

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Bony lump(s)•Asymptomatic•20-30% of people•Females: males = 2:1•No tx necessary•Unless need dentures

Torus Palatinus•

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Bony hard

( torus)

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On the _____, Look for: •Rugae (normal) = Horizontal ridges•Torus palatinus (normal) = Bony lump•Ulcerations•Lesions

Hard palate

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The increase in HSV-2 is due partly to lack of prior
exposure to ______ increased sexual activity, and
lack of barrier contraception.

HSV-1,

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returns quickly to original shape

Spongy =

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•having small bump-like elevations or projections

Papillary

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An elevated, deep solid lesion .5 – 2.0 cm. •Overlying mucosa not fixed•Ex: fibroma

Nodule•

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(pressure alters its shape)

Compressible

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INFECTIONS OF THE THUMBS OR

FINGERS. • GROUPED, FLUID OR PUS FILLED. • USUALLY, ITCH AND /OR PAINFUL

HERPETIC WHITLOW

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attached to the surface on a broad base.•Immobile, fixed

Sessile•

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color change - freckle

Blanching =

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Recurrent herpes labialis is best treated in the_______

phase.

prodrome

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Under dentures
• Red on palate or tongue
• Burn w/ spicy foods & alcohol

Atrophic Candidiasis

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Diabetes
Hormone Changes 
Menopause 
Pregnancy 
Depression/ anxiety 
Radiation for head and neck cancer 
Auto immune disease

Medical History that can indicate Xerostomia

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

Linea Alba•

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• Prodromal signs-tingling, itching,
pain, burning. Arise 6-24 hours
before lesions develop. • multiple fluid-filled blisters • merge and collapse • yellowish crust • 2 weeks healing

Herpes Simplex

I could not think of better way to ask this.

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More common in African-Americans•“milky” white surface or blue-grey•Symmetrical•Doesn’t rub off•Disappears / decreases when stretched•normal

Leukoedema•

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bony elevation or prominence

Torus•

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A denuded area extending below the basal layer•Gradual tissue disintegration•Usually, painful•Ex: aphthous or herpes simplex

Ulcer•

(returns slowly to original shape)

Doughy

Small (<1 cm.) vesicular-type lesion containing purulent material rather than clear fluid•Creamy white or yellow•Ex: dental abscess

Pustule•

firm but not as hard as bone (solid rubber ball) •

Induration =

an outer layer, covering, or scab, from a coagulation of blood, serum, pus, or any combination

Crust•

_______ suspension-initiated during the first 3 symptomatic days in a rinse-and-swallow techniques 5x/day for 5 days. Significant acceleration in clinical resolution is seen.

Acyclovir

White plaque • Looks like hyperkeratosis • But rubs off • Inside the corners, buccal mucosa, lateral tongue

Visual evidence of Candidiasis

Canker Sores (aphthous ulcers) vs. cold sores (herpes simplex)

``` • no blister • generally larger • rarely merge • movable intraoral tissue • tongue, buccal mucosa, soft palate, inner lip ```

Sulfur-colored•Very common•Asymptomatic•1-3mm papules in the oral cavity•Or lip vermillion

Fordyce granules•

Risks of Candidiasis

``` Immunocompromised • Pregnancy • Poor oral hygiene • Smoking • Stress • Depression ``` ``` Birth control pills • Long term AB • Diabetes • Dentures that don’t fit • Xerostomia • Iron, B12 deficiency ```

contents expressed - abscess

Collapsing =

Which is an example of a sealing agent used for aphthous ulcers

ameseal

Trapped debris: Bacteria • Fungus • Coffee • Tobacco • Antibiotics and other drugs can cause.

Hairy Tongue

``` •Larger than minor aphthae-usually 1-3cm. •Have the longest duration per episode. •Ulcerations are deeper and can take 2-6 weeks to heal. •May cause scarring. •Lesions vary from 1-10 •Onset is after puberty ```

MAJOR APHTHOUS ULCERATIONS

Which apthous ulcer treatment is probably best

Local anti-inflammatory: • Kenalog in Orabase 2- 4x / day

A solid, flat, raised area >1cm.•Often keratinized (white)•Ex: Snuff dipper’s lesion

Plaque•

Vesicular form of a canker sore

Herpetiform

A superficial, elevated, solid lesion <1 cm.•Any color•Solid base or pedunculated•Ex: parulis •(“gum boil”)

Papule•

What are the 4 areas at high risk for oral cancer?

Floor of mouth, lateral border of tongue, ventral surface of tongue, and oropharynx

On the _____, Depress tongue•Say “Ah”•Look for: •Ulcers•Patches

Soft palate

Ulcers arise almost exclusively on nonkeratinized mucosa and may be preceded by an erythematous macule in association with prodromal symptoms of burning, itching, or stinging.

MINOR APHTHOUS ULCERATIONS

stone in salivary gland

Sialolithiasis

``` • White plaque • Looks like hyperkeratosis •But rubs off • Inside the corners, buccal mucosa, lateral tongue ```

Chronic Hyperplastic Candidiasis

Small (<1 cm) fluid filled, elevated lesion with a thin surface covering •= Small blister•Lymph or serum•Ex: Herpes simplex (before it bursts)

Vesicle•

What are the symptoms of xerostomia

``` candidiasis angular chelitis Burning tongue Root and Cervical caries stomatitis Dysphagia ```

Mandibular duct

Wharton's

• Greatest number of lesions and most frequent recurrence. • Lesions are small 1-3mm with as many as 100 ulcers present in a single recurrence. • Because of their small size and large number, the lesions bear a superficial resemblance to a primary HSV infection.

HERPETIFORM APHTHOUS ULCERATIONS

_______ exposure correlates directly with sexual | activity.

HSV-2

How do you treat a symptomatic apthous ulcer

* Viscous benzocaine | * Oragel, Anbesol

nonhealing ulcer, bleeding, lymphadenopathy, hardness, pain, paresthesia, and drooling are signs and symptoms of ____

Oral cancer

Where is the type 1 Herpe simplex fever blisters located?

mouth, lips, face

``` 60% of U.S. pop. • starts around 10-20 yrs. old • frequency varies • prodromal tingling • 3 days pain, 7 days healed • If mild disease-treatment is topical corticosteroids. ```

Aphthous Ulcers (“Canker Sores”)

Where is Candidiasis "thrush" seen in an intraoral exam?

Tongue Buccal mucosa Soft palate

``` White or grayish thick keratotic patch-like lesion on the mucosa which cannot be rubbed off ```

Leukoplakia

``` Tends to occur along family lines. When both parents have a history of aphthous ulcers, there is a 90% chance that their children will develop the lesions. ```

Aphthous Lesions

elevated lesions having a narrow stem which acts as a base. Elongated stalk

Pedunculated lesion•

Sjogren's syndrome

autoimmune disease that results in dry mouth

•Red area of variable size and shape.•Usually in patches

Erythema:

(yields to pressure but keeps its shape)

Firm

Small (<1 cm) circumscribed area of color change•Brown, black, blue, red•Not elevated or depressed•Ex: freckle (=ephelis)

Macule

round red pinpoint areas of hemorrhage.Usually cause by trauma, viral infection or bleeding problems

PETECHIA(E)

Dialated blood vessels on the ventral surface of the tongue

lingual varicosities

What symptoms accompany SEVERE PRIMARY INFECTIONS of PRIMARY HERPES GINGIVOSTOMATITIS

ACCOMPANIED BY HIGH FEVER, MALAISE, CERVICAL | LYMPHADENOPATHY AND DEHYDRATION

• The ulcerations measure between 3-10mm in diameter, oval, and heal without scatting in 7-14 days. • Usually, 1-5 lesions and the pain is often out of proportion for the size of the ulceration. • Buccal and labial mucosa are affected most frequently followed by the ventral surface of the tongue. • Recurrence rate is highly variable, ranging from one ulceration every few years to two episodes per month.

MINOR APHTHOUS ULCERATIONS

Reddened, pebbled surface of tongue. dry and cracked corners of the mouth. Red or parched mucosal tissues

Clinical Assessment of xerostomia

What are three clincial variations of Aphthous Lesions

Minor, | Major, Herpetiform.

separate, not running together or blending

Discrete •

soft and leaves indentation -edema

Pitting =

A large vesicle •>1 cm.•= large blister•Contains serum•Usually at the mucosal – submucosal junction•Ex: Pemphigus, 2nd degree burn

Bulla•

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

VERRUCOSE (AKA VERRUCOUS) LESION

In the past. Primary herpetic gingivostomatitis was treated symptomatically; however, if the infection is diagnosed early,______ ______ can have a significant influence.

antiviral medications

Interlacing white striae (Wickham) with erythema of the surrounding mucosa.• usually appearing bilaterally•Painful erythematous erosions and ulcers may also occur.

LICHEN PLANUS•

Large (>1 cm) circumscribed area of color or texture change (or both)•Not elevated or depressed•Ex: port wine stain

Patch•

Lesion of the hard palate.•Lesion is white, rough, asymptomatic, and leathery appearing•Contains numerous red dots or macules

NICOTINE STOMATITIS•

``` For Aphthous Lesions, Although no single triggering agent is responsible, the mucosal destruction appears to represent a ______ mediated immunologic reaction. ```

T-cell

Bony lump(s)•Asymptomatic•More common w/ bruxism?•8-16% of people•Males = females•No tx necessary•Unless need dentures

Torus Mandibularis•

Most common Candidiasis ``` •Tongue, buccal mucosa, floor •Creamy white patches •Easily wipe off leaving an erythematous base •Pain w/ spicy / acidic foods •Xerostomia •Dysphagia ```

Acute Pseudomembranous Candidiasis

a sloughing (shedding) of epithelium caused by disease, trauma, or chemical burn•i.e., aspirin bu

Eschar•

Antibodies to _______ decrease the chance of infection with HSV-2 or lessen the severity of the clinical manifestations.

HSV-1

THE LESIONS OFTEN HEAL IN ONE AREA AND THEN MOVE (MIGRATE) TO A DIFFERENT PART OF THE TONGUE. ``` ALSO CALLED GEOGRAPHIC TONGUE . USUALLY ASYMPTOMATIC BUT CAN CAUSE DISCOMFORT, PAIN OR BURNING SENSATION IN SOME CASES, OFTEN RELATED TO EATING SPICY OR ACIDIC FOODS ```

BENIGN MIGRATORY GLOSSITIS

Ways to treat Candidiasis

``` • Oral hygiene • Yogurt, acidophilus • Avoid alcohol, simple sugars • Medications • Nystatin •rinse and tablets • Ketaconozole • Fluconozole ```

Herpes Simplex that IS SEEN MAINLY IN CHILDREN AND IS CAUSED BY HS1 IN MOST CASES.

PRIMARY HERPES GINGIVOSTOMATITIS

Caused by the Epstein-Barr virus and is usually associated HIV infection or other immunosuppressive conditions. Typically occurs on the lateral border of the tongue. Either unilateral or bilateral. White rough patches.

Hairy Leukoplakia