Lecture 9: Oral Cavity Flashcards
What is apthous stomatitis?
Canker sores, usually due to stress or Herpes virus 6
What clinical findings would I expect for an apthous stomatitis?
- Painful, small, round ulceration with yellow gray center surrounded by red halos.
- Recurrent
- Single or multiple
- Buccal or labial mucosa
What treatments are suggested for apthous stomatitis?
- Viscous lidocaine
- Topical corticosteroids (triamcinolone)
- Prednisone for 1 week if severe
- Magic mouthwash
If we are unclear if a sore is apthous stomatitis, what should we do next?
Incisional biopsy.
What is herpes gingivostomatitis?
Cold sore
What are the primary causes of cold sores?
- 90% HSV1
- HSV2
How does a cold sore typically present?
- Mild, short-lived
- Prodromal period of malaise and fever
- May be recurrent in immunocompromised.
What are the precipitating factors for cold sores?
- Oral trauma
- Sunburn
- Stress
- Febrile Illness
What clinical findings would I expect in herpes gingivostomatitis?
- Initial burning
- Scabbing from small vesicles
- Cervical adenopathy
- Dehydration
- Aura of itching, tingling, and burning prior to vesicle formation.
How do we diagnose herpes gingivostomatitis?
- Usually just clinical.
- PCR test for HSV
- Can do Tzanck smear for multinucleated giant cells.
How do I differentiate between apthous lesions and cold sores?
- Apthous tend to occur on movable oral mucosa
- Apthous has no vesicles
How do you treat herpes gingivostomatitis?
- Oral antivirals to shorten duration if no vesicle eruption yet.
- Viscous lidocaine
What is oral candidiasis also known as?
Thrush
What are the risk factors for oral candidiasis?
- Infants
- Dentures
- DM
- Immunocompromised
- Chemo/radiation
- ABX or corticosteroid use
What are the clinical findings for oral candidiasis?
- 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)
How do we diagnose oral candidiasis?
- Clinical
- Wet prep with KOH showing budding yeast w or w/o pseudohyphae (PREFERRED)
- Biopsy
How do we treat oral candidiasis?
- Nystatin rinse
- Fluconazole (if rinse failed)
- Magic mouthwash w/ nystatin
If from breastfeeding, must treat mother as well.
Which of the following is the best treatment for apthous ulcers?
* Supportive treatment
* Acyclovir
* Topical ABX
Supportive treatment
What is the best diagnostic tool for herpes gingivostomatitis?
PCR testing
Tzanck smear is less sensitive.
What is angular cheilitis?
Inflammatory lesions of the corner of the mouth, often characterized by scaling and fissuring of the mouth.
Who MC gets angular cheilitis?
Elderly
What is the usual predisposing factor for angular cheilitis?
Maceration, leading to C. albicans invasion.
How do we treat angular cheilitis?
- Topical clotrimazole or miconazole
How do we prevent angular cheilitis?
- Advise to stop licking lips
- Recommend lip balm
- Properly fit dentures
What is glossitis?
Inflammation of the tongue and loss of filiform papillae resulting in a red, smooth surfaced tongue.
Rarely painful.
What are the typical etiologies of glossitis?
- Nutritional deficiencies
- Drug rxns
- Dehydration
- Irritants
- Foods and liquids
- Autoimmune rxns
- Psoriasis
How do we treat glossitis?
Empiric nutritional replacement therapy if underlying cause cannot be identified.
What is glossodynia often called?
Burning mouth syndrome
What is glossodynia?
Intraoral burning sensation in the mouth, with no identifiable cause.
Who is glossodynia without glossitis MC in?
Postmenopausal women.
Who is glossodynia with glossitis MC in?
- DM
- Drugs (diuretics)
- Tobacco use
- Xerostomia
- Candidiasis
How do we treat glossodynia?
- Clonazepam
- TCAs
- Behavioral therapy
If a cause of glossitis cannot be identified, what is the best treatment option?
Empiric nutritional replacement therapy.
What is the best treatment for angular cheilitis?
Topical antifungal like clotrimazole or miconazole.
What is leukoplakia?
Hyperkeratosis occurring in response to chronic irritation.
How does leukoplakia often present?
White, patchy lesion that CANNOT be scraped off.
Although rare, what can leukoplakia often be the precusor to?
Dysplasia or early invasive squamous cell carcinoma.
What is a must in management for leukoplakia?
Biopsy ALWAYS if history of tobacco.
How do we treat leukoplakia?
- Surgical removal
- Eliminate alcohol or tobacco
What is erythroplakia?
Definite erythematous component instead of the white patch in leukoplakia.
How does erythoplakia typically present?
Fiery red, sharply demarcated patch on the floor of the mouth, ventral tongue, or soft palate.
Who is erythroplakia MC in?
Elderly with tobacco use and alcohol use
What is the main concern with erythroplakia?
High risk of malignant transformation into squamous cell carcinoma.
How do we manage erythroplakia?
Refer to surgical excision and biopsy.
Eliminate alcohol and tobacco use.
What is hairy leukoplakia?
Slightly raised, leukoplakic areas with a hair surface, often on the LATERAL aspects of the tongue.
What group is MC for hairy leukoplakia?
- HIV infection
- EBV infection
How do we treat hairy leukoplakia?
- HAART
- Oral antivirals
- Topical podophyllin
What is oral lichen planus?
A chronic, inflammatory, autoimmune disease with reticular/lacy patterns
Often painless.
How do we definitively diagnose oral lichen planus?
Biopsy
How do we treat oral lichen planus?
- High-potency corticosteroids (first line), clobetasol
- Oral steroids if severe
- Good oral hygiene
- Smoking cessation
What is geographic tongue?
Benign migratory glossitis, presenting with scalloped borders and changing borders.
What is the treatment for benign migratory tongue?
No treatment, since no risk of malignancy and usually mild symptoms.
What is black tongue?
Hyperpigmentation of the tongue and oral mucosa, usually seen in dark-skinned individuals.
What are some causes of black tongue?
- Drugs (peptobismol)
- Addison’s
What is hairy tongue?
Retention of keratin on tips of filiform papillae.
What usually causes hairy tongue?
- Smoking
- Coffee
- Tea
- Poor oral hygiene
How do you treat hairy tongue?
Oral hygiene improvement.
Which tongue condition is most closely related to oral malignancy?
Erythroplakia
What is the best diagnostic tool for leukoplakia?
Biopsy
What is sialolithiasis?
Calculus formation in one of the ducts that drain the salivary glands.
Where does sialolithiasis MC occur?
Wharton’s duct, draining the submandibular gland. (longer duct)
What clinical findings would I expect for sialolithiasis?
- Postprandial pain
- Swelling
- Spasm upon eating
How do we diagnose sialolithiasis?
CT imaging
How do we treat sialolithiasis?
- Local heat
- Massage
- Hydration
- Small stones: salivary secretion using sialogogues or sour candy
- Large: incise duct or sialendoscopy
What are the two types of parotitis?
Suppurative and non-suppurative
What are the MC causes of suppurative parotitis?
- MC: staph Aureus
- Anaerobes
- Often polymicrobial
What are MCC of non-suppurative parotitis?
- Viral
- CF
- DM
- Alcoholism
- Gout
- Tumors
Who is suppurative parotitis MC in?
Elderly postop who are dehydrated/intubated and have salivary stasis.
What are the common etiologies for suppurative parotitis?
- Elderly dehydrated/intubated postop
- Intensive teeth cleaning
- Anticholinergics
- Malnutrition
- Ductal obstruction
What clinical findings suggest suppurative parotitis?
- Acute swelling of salivary gland (firm, erythematous)
- Increased pain during eating
- Trismus and dysphagia
- Pus
- Fever
- Unilateral (usually)
How do we image/diagnose suppurative parotitis?
- CT for stone/abscess/tumor
- Clinical diagnosis
- Expression of purulent material from stenson’s duct/needle aspiration
- Elevated serum amylase
How do you treat suppurative parotitis?
- 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.
What are the complications of suppurative parotitis?
- Progression of infection
- Fistula
What are the MC viruses that cause non-suppurative parotitis?
Parainfluenza and EBV.
Is non-suppurative parotitis bilateral or unilateral?
Usually bilateral
How do we treat non-suppurative parotitis?
Self-limiting, supportive care.
What is the MCC of sialadenitis of the submandibular gland?
Staph Aureus
How does sialadenitis present?
- Erythema over the submandibular with tenderness and swelling.
- Purulent material possible
- CT imaging of choice
How do we treat sialadenitis?
- Hydration
- Warm compresses
- IV ABX like parotid sialadenitis
- I&D abscess or if unresponsive to therapy
If a patient does not respond to IV abx in 48 hours for sialadenitis, what is the next step?
Surgical referral for I&D
What is the MCC of non-suppurative parotitis?
Parainfluenza and EBV
What oral abx is indicated for suppurative sialadenitis?
- Clinda + Cipro
- Augmentin
What is the single MC chronic childhood disease?
Early childhood caries (Cavities)
What are dental caries?
Multifactorial, infectious, communicable disease that results in demineralization of tooth enamel in the presence of sugar substrate and acid.
What bacteria is the MC for causing dental caries?
Streptococcus mutans
What is the danger of not removing plaque from teeth?
Tartar formation and destructive gum disease.
What are the risk factors for dental caries in kids?
- 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)
How do we manage dental caries?
- Education!!
- Dental referral by age 1
- Prescribe fluoride as needed
- Fluoride varnish
What are the various forms fluoride can be formulated in?
- Oral drops, chewable tablets
- Lozenges
- Gel, paste, oral rinse
- Fluoride varnish
What syndrome predisposes an adult to dental caries?
Sjogren’s (dry mouth)
How do adult dental caries present?
- Brownish discoloration
- Non-localized pain upon exposure to heat or cold
- Dental bacterial plaque
- Pulpitis can occur as infection spreads.
How do we manage/treat dental caries in adults?
- Refer to dentist
- Educate
- Fluoride mouth rinses
- Treat xerostomia
How does a dental abscess present?
An acute lesion characterized by localization of pus in the structures that surround the teeth.
What clinical findings are common in dental abscesses?
- Dental pain
- Toothache
- Gingival edema or erythema
- Discharge
- Thermal hypersensitivity
- Fluctuant mass
- Trismus
How do you treat small dental abscesses?
- PCN VK +/- metro
- Clinda for PCN allergy.
- Analgesics
- Chlorhexidine mouth rinse
How do you treat large dental abscesses?
- I&D
- IV ABX
- Dental referral
What is gingivitis?
Inflammation of the gingiva, but is reversible!
What can cause gingivitis medication-wise?
- Steroid hormones
Gingival hyperplasia: - CCBs
- Phenytoin
- Cyclosporine
How do you diagnose gingivitis?
Clinical
How do you treat gingivitis?
- Good oral hygiene
- Flossing
What is acute necrotizing ulcerative gingivitis?
Trench mouth/vincent’s angina
What is the MCC of trench mouth?
Oral anaerobic fusiform bacteria and spirochetes.
How does trench mouth typically present?
- Painful, inflamed gingiva with uclerations that bleed easily
- Halitosis
- Fever, malaise
- Lymphadenopathy
How do you treat trench mouth?
- Debridement, followed by 1 of 3 abx:
- Metro
- Clinda
- Augmentin
- Warm 50% peroxide rinses or chlorhexidine rinses for adjunct.
What is periodontitis?
A complication of chronic gingivitis in which there is a loss of connective tissue and bone support for the teeth.
What are the consequences/effects of periodontitis?
Tooth loss in adults
How is periodontitis classified?
- Appearance: ulcerative or hemorrhagic
- Etiology: drugs or hormones
- Duration: acute or chronic
- Quality: mild, moderate, severe
What is the most common dental condition that is induced by plaque formation?
Periodontitis
How do we manage periodontitis?
- Refer to dentist
- Educate on good oral hygiene
What is dry socket?
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.
What are the risk factors for dry socket?
- Smoking
- Preexisting periodontal disease
- Traumatic disease
- Prior hx of alveolar osteitis
- Hormone replacement therapy?
What is the management for dry socket?
- Refer to dentist
- PCN VK or clinda
