Intraoral Exams Flashcards
Where is the type 2 Herpe simplex fever blisters located?
genital
• 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
- 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
What is the difference between Minor and Major Canker sores
Minor: <1 cm and shallow
Major > 1 cm and deeper
Which is the only FDA approved treatment for canker sores? What is significant about it.
Aphthasol
must be started early in the prodromal stage.
Running together, blended. Originally separate but now formed into one.
CONFLUENT
Bony lump(s)•Asymptomatic•20-30% of people•Females: males = 2:1•No tx necessary•Unless need dentures
Torus Palatinus•
Bony hard
( torus)
On the _____, Look for: •Rugae (normal) = Horizontal ridges•Torus palatinus (normal) = Bony lump•Ulcerations•Lesions
Hard palate
The increase in HSV-2 is due partly to lack of prior
exposure to ______ increased sexual activity, and
lack of barrier contraception.
HSV-1,
returns quickly to original shape
Spongy =
•having small bump-like elevations or projections
Papillary
An elevated, deep solid lesion .5 – 2.0 cm. •Overlying mucosa not fixed•Ex: fibroma
Nodule•
(pressure alters its shape)
Compressible
INFECTIONS OF THE THUMBS OR
FINGERS. • GROUPED, FLUID OR PUS FILLED. • USUALLY, ITCH AND /OR PAINFUL
HERPETIC WHITLOW
attached to the surface on a broad base.•Immobile, fixed
Sessile•
color change - freckle
Blanching =
Recurrent herpes labialis is best treated in the_______
phase.
prodrome
Under dentures
• Red on palate or tongue
• Burn w/ spicy foods & alcohol
Atrophic Candidiasis
Diabetes Hormone Changes Menopause Pregnancy Depression/ anxiety Radiation for head and neck cancer Auto immune disease
Medical History that can indicate Xerostomia
white line •parallel to occlusal plane •Asymptomatic•Caused by trauma •Chewing cheek
Linea Alba•
• 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.
More common in African-Americans•“milky” white surface or blue-grey•Symmetrical•Doesn’t rub off•Disappears / decreases when stretched•normal
Leukoedema•
bony elevation or prominence
Torus•
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
