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(C) CM 1B: ID/EENT > Lecture 9: Oral Cavity > Flashcards

Lecture 9: Oral Cavity Flashcards

1
Q

What is apthous stomatitis?

A

Canker sores, usually due to stress or Herpes virus 6

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2
Q

What clinical findings would I expect for an apthous stomatitis?

A
  • Painful, small, round ulceration with yellow gray center surrounded by red halos.
  • Recurrent
  • Single or multiple
  • Buccal or labial mucosa
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3
Q

What treatments are suggested for apthous stomatitis?

A
  • Viscous lidocaine
  • Topical corticosteroids (triamcinolone)
  • Prednisone for 1 week if severe
  • Magic mouthwash
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4
Q

If we are unclear if a sore is apthous stomatitis, what should we do next?

A

Incisional biopsy.

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5
Q

What is herpes gingivostomatitis?

A

Cold sore

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6
Q

What are the primary causes of cold sores?

A
  • 90% HSV1
  • HSV2
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7
Q

How does a cold sore typically present?

A
  • Mild, short-lived
  • Prodromal period of malaise and fever
  • May be recurrent in immunocompromised.
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8
Q

What are the precipitating factors for cold sores?

A
  • Oral trauma
  • Sunburn
  • Stress
  • Febrile Illness
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9
Q

What clinical findings would I expect in herpes gingivostomatitis?

A
  • Initial burning
  • Scabbing from small vesicles
  • Cervical adenopathy
  • Dehydration
  • Aura of itching, tingling, and burning prior to vesicle formation.
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10
Q

How do we diagnose herpes gingivostomatitis?

A
  • Usually just clinical.
  • PCR test for HSV
  • Can do Tzanck smear for multinucleated giant cells.
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11
Q

How do I differentiate between apthous lesions and cold sores?

A
  • Apthous tend to occur on movable oral mucosa
  • Apthous has no vesicles
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12
Q

How do you treat herpes gingivostomatitis?

A
  • Oral antivirals to shorten duration if no vesicle eruption yet.
  • Viscous lidocaine
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13
Q

What is oral candidiasis also known as?

A

Thrush

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14
Q

What are the risk factors for oral candidiasis?

A
  • Infants
  • Dentures
  • DM
  • Immunocompromised
  • Chemo/radiation
  • ABX or corticosteroid use
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15
Q

What are the clinical findings for oral candidiasis?

A
  • Painful, burning tongue
  • Creamy-white curd like patches overlying erythematous mucosa (beefy red tongue)
  • CAN BE SCRAPED OFF with tongue blade. (Leukoplakia cannot be scraped off)
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16
Q

How do we diagnose oral candidiasis?

A
  • Clinical
  • Wet prep with KOH showing budding yeast w or w/o pseudohyphae (PREFERRED)
  • Biopsy
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17
Q

How do we treat oral candidiasis?

A
  • Nystatin rinse
  • Fluconazole (if rinse failed)
  • Magic mouthwash w/ nystatin

If from breastfeeding, must treat mother as well.

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18
Q

Which of the following is the best treatment for apthous ulcers?
* Supportive treatment
* Acyclovir
* Topical ABX

A

Supportive treatment

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19
Q

What is the best diagnostic tool for herpes gingivostomatitis?

A

PCR testing

Tzanck smear is less sensitive.

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20
Q

What is angular cheilitis?

A

Inflammatory lesions of the corner of the mouth, often characterized by scaling and fissuring of the mouth.

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21
Q

Who MC gets angular cheilitis?

A

Elderly

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22
Q

What is the usual predisposing factor for angular cheilitis?

A

Maceration, leading to C. albicans invasion.

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23
Q

How do we treat angular cheilitis?

A
  • Topical clotrimazole or miconazole
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24
Q

How do we prevent angular cheilitis?

A
  • Advise to stop licking lips
  • Recommend lip balm
  • Properly fit dentures
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25
Q

What is glossitis?

A

Inflammation of the tongue and loss of filiform papillae resulting in a red, smooth surfaced tongue.

Rarely painful.

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26
Q

What are the typical etiologies of glossitis?

A
  • Nutritional deficiencies
  • Drug rxns
  • Dehydration
  • Irritants
  • Foods and liquids
  • Autoimmune rxns
  • Psoriasis
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27
Q

How do we treat glossitis?

A

Empiric nutritional replacement therapy if underlying cause cannot be identified.

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28
Q

What is glossodynia often called?

A

Burning mouth syndrome

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29
Q

What is glossodynia?

A

Intraoral burning sensation in the mouth, with no identifiable cause.

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30
Q

Who is glossodynia without glossitis MC in?

A

Postmenopausal women.

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31
Q

Who is glossodynia with glossitis MC in?

A
  • DM
  • Drugs (diuretics)
  • Tobacco use
  • Xerostomia
  • Candidiasis
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32
Q

How do we treat glossodynia?

A
  • Clonazepam
  • TCAs
  • Behavioral therapy
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33
Q

If a cause of glossitis cannot be identified, what is the best treatment option?

A

Empiric nutritional replacement therapy.

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34
Q

What is the best treatment for angular cheilitis?

A

Topical antifungal like clotrimazole or miconazole.

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35
Q

What is leukoplakia?

A

Hyperkeratosis occurring in response to chronic irritation.

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36
Q

How does leukoplakia often present?

A

White, patchy lesion that CANNOT be scraped off.

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37
Q

Although rare, what can leukoplakia often be the precusor to?

A

Dysplasia or early invasive squamous cell carcinoma.

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38
Q

What is a must in management for leukoplakia?

A

Biopsy ALWAYS if history of tobacco.

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39
Q

How do we treat leukoplakia?

A
  • Surgical removal
  • Eliminate alcohol or tobacco
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40
Q

What is erythroplakia?

A

Definite erythematous component instead of the white patch in leukoplakia.

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41
Q

How does erythoplakia typically present?

A

Fiery red, sharply demarcated patch on the floor of the mouth, ventral tongue, or soft palate.

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42
Q

Who is erythroplakia MC in?

A

Elderly with tobacco use and alcohol use

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43
Q

What is the main concern with erythroplakia?

A

High risk of malignant transformation into squamous cell carcinoma.

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44
Q

How do we manage erythroplakia?

A

Refer to surgical excision and biopsy.
Eliminate alcohol and tobacco use.

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45
Q

What is hairy leukoplakia?

A

Slightly raised, leukoplakic areas with a hair surface, often on the LATERAL aspects of the tongue.

46
Q

What group is MC for hairy leukoplakia?

A
  • HIV infection
  • EBV infection
47
Q

How do we treat hairy leukoplakia?

A
  • HAART
  • Oral antivirals
  • Topical podophyllin
48
Q

What is oral lichen planus?

A

A chronic, inflammatory, autoimmune disease with reticular/lacy patterns
Often painless.

49
Q

How do we definitively diagnose oral lichen planus?

A

Biopsy

50
Q

How do we treat oral lichen planus?

A
  • High-potency corticosteroids (first line), clobetasol
  • Oral steroids if severe
  • Good oral hygiene
  • Smoking cessation
51
Q

What is geographic tongue?

A

Benign migratory glossitis, presenting with scalloped borders and changing borders.

52
Q

What is the treatment for benign migratory tongue?

A

No treatment, since no risk of malignancy and usually mild symptoms.

53
Q

What is black tongue?

A

Hyperpigmentation of the tongue and oral mucosa, usually seen in dark-skinned individuals.

54
Q

What are some causes of black tongue?

A
  • Drugs (peptobismol)
  • Addison’s
55
Q

What is hairy tongue?

A

Retention of keratin on tips of filiform papillae.

56
Q

What usually causes hairy tongue?

A
  • Smoking
  • Coffee
  • Tea
  • Poor oral hygiene
57
Q

How do you treat hairy tongue?

A

Oral hygiene improvement.

58
Q

Which tongue condition is most closely related to oral malignancy?

A

Erythroplakia

59
Q

What is the best diagnostic tool for leukoplakia?

A

Biopsy

60
Q

What is sialolithiasis?

A

Calculus formation in one of the ducts that drain the salivary glands.

61
Q

Where does sialolithiasis MC occur?

A

Wharton’s duct, draining the submandibular gland. (longer duct)

62
Q

What clinical findings would I expect for sialolithiasis?

A
  • Postprandial pain
  • Swelling
  • Spasm upon eating
63
Q

How do we diagnose sialolithiasis?

A

CT imaging

64
Q

How do we treat sialolithiasis?

A
  • Local heat
  • Massage
  • Hydration
  • Small stones: salivary secretion using sialogogues or sour candy
  • Large: incise duct or sialendoscopy
65
Q

What are the two types of parotitis?

A

Suppurative and non-suppurative

66
Q

What are the MC causes of suppurative parotitis?

A
  • MC: staph Aureus
  • Anaerobes
  • Often polymicrobial
67
Q

What are MCC of non-suppurative parotitis?

A
  • Viral
  • CF
  • DM
  • Alcoholism
  • Gout
  • Tumors
68
Q

Who is suppurative parotitis MC in?

A

Elderly postop who are dehydrated/intubated and have salivary stasis.

69
Q

What are the common etiologies for suppurative parotitis?

A
  • Elderly dehydrated/intubated postop
  • Intensive teeth cleaning
  • Anticholinergics
  • Malnutrition
  • Ductal obstruction
70
Q

What clinical findings suggest suppurative parotitis?

A
  • Acute swelling of salivary gland (firm, erythematous)
  • Increased pain during eating
  • Trismus and dysphagia
  • Pus
  • Fever
  • Unilateral (usually)
71
Q

How do we image/diagnose suppurative parotitis?

A
  • CT for stone/abscess/tumor
  • Clinical diagnosis
  • Expression of purulent material from stenson’s duct/needle aspiration
  • Elevated serum amylase
72
Q

How do you treat suppurative parotitis?

A
  • IV ABX initially, using nafcillin/1st gen cephalo PLUS metro or clinda.
  • Vanco if MRSA.
  • Oral abx when improved: clinda + cipro or augmentin alone.
  • Hydration
  • Surgical I&D if no response after 48 hrs of IV ABX.
73
Q

What are the complications of suppurative parotitis?

A
  • Progression of infection
  • Fistula
74
Q

What are the MC viruses that cause non-suppurative parotitis?

A

Parainfluenza and EBV.

75
Q

Is non-suppurative parotitis bilateral or unilateral?

A

Usually bilateral

76
Q

How do we treat non-suppurative parotitis?

A

Self-limiting, supportive care.

77
Q

What is the MCC of sialadenitis of the submandibular gland?

A

Staph Aureus

78
Q

How does sialadenitis present?

A
  • Erythema over the submandibular with tenderness and swelling.
  • Purulent material possible
  • CT imaging of choice
79
Q

How do we treat sialadenitis?

A
  • Hydration
  • Warm compresses
  • IV ABX like parotid sialadenitis
  • I&D abscess or if unresponsive to therapy
80
Q

If a patient does not respond to IV abx in 48 hours for sialadenitis, what is the next step?

A

Surgical referral for I&D

81
Q

What is the MCC of non-suppurative parotitis?

A

Parainfluenza and EBV

82
Q

What oral abx is indicated for suppurative sialadenitis?

A
  • Clinda + Cipro
  • Augmentin
83
Q

What is the single MC chronic childhood disease?

A

Early childhood caries (Cavities)

84
Q

What are dental caries?

A

Multifactorial, infectious, communicable disease that results in demineralization of tooth enamel in the presence of sugar substrate and acid.

85
Q

What bacteria is the MC for causing dental caries?

A

Streptococcus mutans

86
Q

What is the danger of not removing plaque from teeth?

A

Tartar formation and destructive gum disease.

87
Q

What are the risk factors for dental caries in kids?

A
  • Repetitve use of sippy cup with sugary drinks.
  • Sticky foods
  • Sleeping with bottle
  • Non-fluoridated water or bottled water
  • Low socioeconomic status
  • Medications containing sugar or causing dryness (anticholinergics)
88
Q

How do we manage dental caries?

A
  • Education!!
  • Dental referral by age 1
  • Prescribe fluoride as needed
  • Fluoride varnish
89
Q

What are the various forms fluoride can be formulated in?

A
  • Oral drops, chewable tablets
  • Lozenges
  • Gel, paste, oral rinse
  • Fluoride varnish
90
Q

What syndrome predisposes an adult to dental caries?

A

Sjogren’s (dry mouth)

91
Q

How do adult dental caries present?

A
  • Brownish discoloration
  • Non-localized pain upon exposure to heat or cold
  • Dental bacterial plaque
  • Pulpitis can occur as infection spreads.
92
Q

How do we manage/treat dental caries in adults?

A
  • Refer to dentist
  • Educate
  • Fluoride mouth rinses
  • Treat xerostomia
93
Q

How does a dental abscess present?

A

An acute lesion characterized by localization of pus in the structures that surround the teeth.

94
Q

What clinical findings are common in dental abscesses?

A
  • Dental pain
  • Toothache
  • Gingival edema or erythema
  • Discharge
  • Thermal hypersensitivity
  • Fluctuant mass
  • Trismus
95
Q

How do you treat small dental abscesses?

A
  • PCN VK +/- metro
  • Clinda for PCN allergy.
  • Analgesics
  • Chlorhexidine mouth rinse
96
Q

How do you treat large dental abscesses?

A
  • I&D
  • IV ABX
  • Dental referral
97
Q

What is gingivitis?

A

Inflammation of the gingiva, but is reversible!

98
Q

What can cause gingivitis medication-wise?

A
  • Steroid hormones
    Gingival hyperplasia:
  • CCBs
  • Phenytoin
  • Cyclosporine
99
Q

How do you diagnose gingivitis?

A

Clinical

100
Q

How do you treat gingivitis?

A
  • Good oral hygiene
  • Flossing
101
Q

What is acute necrotizing ulcerative gingivitis?

A

Trench mouth/vincent’s angina

102
Q

What is the MCC of trench mouth?

A

Oral anaerobic fusiform bacteria and spirochetes.

103
Q

How does trench mouth typically present?

A
  • Painful, inflamed gingiva with uclerations that bleed easily
  • Halitosis
  • Fever, malaise
  • Lymphadenopathy
104
Q

How do you treat trench mouth?

A
  • Debridement, followed by 1 of 3 abx:
  • Metro
  • Clinda
  • Augmentin
  • Warm 50% peroxide rinses or chlorhexidine rinses for adjunct.
105
Q

What is periodontitis?

A

A complication of chronic gingivitis in which there is a loss of connective tissue and bone support for the teeth.

106
Q

What are the consequences/effects of periodontitis?

A

Tooth loss in adults

107
Q

How is periodontitis classified?

A
  • Appearance: ulcerative or hemorrhagic
  • Etiology: drugs or hormones
  • Duration: acute or chronic
  • Quality: mild, moderate, severe
108
Q

What is the most common dental condition that is induced by plaque formation?

A

Periodontitis

109
Q

How do we manage periodontitis?

A
  • Refer to dentist
  • Educate on good oral hygiene
110
Q

What is dry socket?

A

Post-extraction alveolar osteitis, that occurs 2nd-3rd day postop.

It is displacement of the clot or fibrinolytic dissolution of the clot, resulting in exposure of the alveolar bone and causing localized osteomyelitis.

111
Q

What are the risk factors for dry socket?

A
  • Smoking
  • Preexisting periodontal disease
  • Traumatic disease
  • Prior hx of alveolar osteitis
  • Hormone replacement therapy?
112
Q

What is the management for dry socket?

A
  • Refer to dentist
  • PCN VK or clinda

(C) CM 1B: ID/EENT (27 decks)

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