Mouth and throat Conditions Flashcards
What is a Stomatitis
inflammation of the mouth with or without ulceration
what are the oral causes of stomatitis
poor hygiene
poor fitting dentures
trauma (hot foods, chemical)
ingested toxins
what are systemic causes of stomatitis
infection (viral, fungal, bacterial)
drug reactions
allergic reactions
chemotherapy/radiation
nutritional deficiencies
what are gingivostomatitis
when inflammation also affects the gingiva
what are mucositis
not to be used interchangeably as this refers to systemic mucosal pathology often as a result of chemo/RT (mouth and gut)
What is benign inflammatory glossitis
aka geographic tongue
benign condition exacerbated by stress, nutritional deficiency or heredity
the pattern changes
no treatment needed
what is “black” hairy tongue
treated with vigorous brushing with abrasive toothpaste
what is “white” hairy tongue
abnormal elongation of filiform papillae secondary to increased keratin deposits
M>F
what are recurrent aphthous ulcers
aka canker sores
last 10-30 days on average
vary in size and shape
what are triggers for aphthous ulcers
decrease in mucosal barrier: trauma, pernicious anemia
increased antigenic exposure: foods, flavoring agents
primary immunosuppression/dysfunction: dehcet’s, crohns, celiac, cyclic neutropenia, HIV/AIDS, STRESS
what is the workup for recurrent aphthous ulcers
CBC
ESR/CRP
iron studies
B12
SS-A(Ro)/SS-B (La)
glucose
thyroid
HSV titers
HIV
what is the treatment for Aphthous ulcers
topical steroids: either rinse or cream/gel
systemic steroid: good for multiple lesions or if in oropharynx
Dexamethasone elixr 0.5mg/5ml
what is the presentation of aphthous ulcers
prodrome: sometimes
duration: 10-14 days
Location: non-keratinized tissue- buccal mucosa, ventral tongue, soft palate
what is the presentation of HSV
prodrome: usually
duration: 10-14 days
location: keratinized tissue - gingiva, lip, hard palate
what is primary herpetic gingivostomatitis
Herpes (HSV1)- primary lesion: highly infectious
primary infection lasts up to 2 weeks
patients are very sick
after initial infection - virus goes into latency
how do you differentate from HSV1 from oral Zoster
oral herpes zoster: unilateral with mandibular or maxillary distribution and HAS a prodrome
how do you treat primary HSV1 for adults
acyclovir or famvir
how do you treat primary HSV1 in kids
oral acyclovir 200mg/5ml suspension
how do you treat recurrent HSV infection
topical: acyclovir or pencyclovir
systemic: vanlacyclovir, famiclovir, acyclovir
What is oral candidiasis
“thrush”
opportunistic organism
m/c w/ dentures, diabetics, infants, elderly, pregnancy, nutritional deficiencies, HIV and other immunosuppressed states
What can cause persistent candidiasis
anemia
poorly controlled/undiagnosed DM
thyroid disease
immunosuppression, chronic steroid or abx use
xerostomia
what labs are ordered with persistent candidiasis
CBC with diff
B12
glucose
thyroid funciton
HIV
nutritional workup
what are the treatments for oral candidiasis
Nystatin
Clortimazole
Fluconazole
what is the treatment of angular cheilitis
topical anti-fungal (nystatin)
fluconazole - single dose
what is pharyngitis and tonsillitis
infection and/or irritation of pharynx and/or tonsils
majority of cases are viral and self limited
bacterial cause is usually strepA (GAS)
What is GAS
Group A Strep (GAS)
tends to occur in 5-15 year olds
dx: confirm using rapid antigen detection test and/or throat culture
what is the treatment of GAS pharyngitis
abx therapy (penicillin or amoxicillin)
cephalexin, azithromycin, erythromycin, clindamycin, cetriaxone
what are the complications of strep pharyngitis
Rheumatic fever/rheumatic heart disease
post-stretococcal glomerulonephritis
What is mononucleosis
EBV - pharyngitis is the most common complain/finding
highest incidence in 15-25 year olds
what is the biggest concern with mononucleosis
splenomegaly with rupture
what is the clinical presentation of mono
prodrome: fatigue, low-grade fever, malaise, myalgias over 1-2 weeks are common
pharyngeal and tonsil symptoms often severe and exudative
lymphadenopathy in almost all cases
what medication should be avoided in exudative tonsilitis (mono)
amoxicillin - may cause a rash
how do you diagnose mono
EBV titer vs monospot: CBC, LFTs
typically a clinical diagnosis
what is the treatment of mono
supportive
what is coxsackie virus
herpangina not caused by herpes virus
children <10 yo
common in summer and fall
“hand, foot and mouth disease” similar eruptions on hands or feet
what is acute tonsillitis
rare in children <2yo
“strep” (bacterial) tonsillitis most common in ages 5-15
viral tonsillitis more common in younger kids
how is chronic tonsillitis classified
7 episodes in 1 year
5 episodes /year x 2 years
3 episodes/year x 3 years
symptoms: chronic sore throat, halitosis, tonsilliths
what is the indication for tonsillectomy
recurrent infections
multiple antibiotic allergies
hx of peritonsillar abscess (PTA)
periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA)
hypertrophy and sleep disordered breathing/OSA
What is seen with PTA
fever, malaise, dysphagia, odynophagia, “hot potato” voice, trismus, bulging of superior tonsil pole and soft palate
DEVIATION OF THE UVULA
what is the treatment for PTA
I&D, IM pen VK if not allergic, pain control and recheck 24 hours
what is the difference between tonsillitis and PTA
uvula midline with tonsillitis and deviated with PTA
What is the first choice medication for dental abscess
amoxicillin but if allergic - consider azythro, metronidazole or clindamycin
What is Ludwigs angina
potentially life threatening cellulitis of the soft tissue of floor of the mouth and neck.
includes submandibular spaces of mouth, spreading to sublingual and submental spaces
often result of dental root infection or mouth injury
what is the clinical presentation of Ludwig’s angina
breathing difficulty (tripod)
AMS/confusion
fever/chills
neck pain/stiffness
neck swelling (not lymphadenopathy)
redness of the neck
weakness, fatigue, excessive tiredness
difficulty swallowing, drooling, earache, trismus
what is the treatment plan for Ludwig’s angina
secure airway - AIRWAY EMERGENCY
IV abx, broad spectrum including MRSA
IV steroids can help with swelling
surgical drainage
what are predisposing factors of Ludwig’s angina
poor oral hygiene
dental caries, recent dental tx
diabetes
ETOH use d/o
malnutrition
immunosuppression
What is Croup
laryngotracheobronchitis
most common cause of stridor in children
2nd year of life (6mo - 6 year, peak 12mo-2 yo)
parainfluenza type 1
barking cough
inspiratory high-pitched stridor
hat is the steeple sign
subglottic narrowing
can be seen with croup
what is epiglottitis
H infleunzae type B (Hib vaccine)
1-5 yo - rapid progression
sitting position head up and mouth open drooling “tripod”
what are the 4Ds of epiglottitis
drooling
dysphagia
dysphonia
distressed respiratory efforts
what can be seen on x-ray with epiglottitis
“thumb print” sign
What is Leukoplakia
white patch or plaque
biopsy
malignant transformation ~10%
What is Erythroplakia
red dysplasia
biopsy/refer ASAP
high malignant transformation - 70%
what is lichen planus
lacy white mucosal change
biopsy
low chance of malignant transformation (unless erosive)
chronic disease of skin and mucous membranes
what are the primary salivary glands
parotid (2)
Submandibular (2)
Sublingual (2)
minor salivary glands (5,000)
What are the two salivary ducts that enter the oral cavity
Whartons ducts - from submandibular glands (side of tongue)
Stensen’s ducts - from parotid glands (across from second molar of upper jaw)
what are the three categories of problems with the salivary glands
altered saliva production
painless swelling
painful swellng
What is Sialadenosis
recurrent painless swelling (parotid gland)
what can cause Sialadenosis
endocrine disorders (DM)
Malnutrition (protein, ETOH, vitamin)
Autonomic dysfunction
what is the treatment for Sialdenosis
correct underlying causes
reassurance
what is the treatment of acute Sialadenitis
B-lactam resistant penicillin or cephalosporins
steroids
fluid replacement
Sialogogues (chewing gum or hard candy)
analgesics
manual massage
topical heat
what is acute Sialdenitis
all possible glands but most commonly parotid
rapid onset of pain, swelling and induration
suppurative discharge from duct
what is recurrent Sialadenitis
mechanical obstruction is the most common factor
how do you work up recurrent Sialadenitis
Ct neck with contrast to rule out stones or intrinsic lesions or abscess
what are the treatment options for recurrent Sialadenitis
oral anaerobes dominate: clindamycin, augmentin, flagyl+cephalopsorin, avelox (fluoroquinalone)
surgical excision of gland is the last resort
what is Sialolithiasis
formation of salivary stones
M>F ages 30 - 60
submandicular > parotid > minor
one of the most common cause of salivary dysfunction
what causes Sialolithiasis
enhanced if stasis of salivary flow
genetic predisposition (kidney stones, gout)
mineralization of mucoid gel
what is the clinical presentation of Sialolithiasis
asymptomatic
recurrent swelling associated with eating
spitting out stones
sialadenitis (infection)
how do you manage Sialothiasis
hydration
massage (posterior -> anterior) + heat
anti-inflammatories
abx if infected
removal of stones
sialendoscopy
surgical excision of affected gland
what is the most common cause of acute non-suppurative sialadenitis in childhood
mumps
what is the most common cause of acute suppurative parotitis
S. aureus, ~strep species
what is the treatment for acute suppurative parotitis
initial empiric antibiotics covering aerobic and anaerobic bacterial
surgical drainage may be indicated when pus has formed
what is laryngitis
inflammation of the larynx, usually viral and occasionally from reflux
usually URI prodrome, then hoarsness
what is the treatment of laryngitis
supportive care, LOTS of fluids, voice rest
when is a laryngoscopic exam required with laryngitis
if dyspneic or hoarsness lasts longer than 1-2 weeks
what is a laryngeal polyp
results of hemorrhagic event: acute phono trauma
90% unilateral
treatment: voice rest, ~excision + voice therapy
