Mouth lesions

Question 1

Gingivitis

Answer 1

red, swollen, bleeding gingiva, reversible if treated

Question 2

Periodontal disease

Answer 2

bone loss, periodontal pocket formation, tooth mobility may be present, halitosis (bad breath)

Question 3

Herpes simplex virus

general

Answer 3

(can cross the waist)

Question 4

HSV-1

general

Answer 4

Question 5

reccurant oral herpes labialis

Cold sore (describe them)

Answer 5

Question 6

Reccurant intraoral herpes

general

Answer 6

Question 7

Answer 7

recurrent intraoral herpes

Question 8

Acute primary herpetic gingivostomatitis

general, Sx, Tx

Answer 8

Question 9

Question 10

Answer 10

acute herpetic gingivostomatitis

Question 11

acute herpetic gingivostomatitis

Tx

Answer 11

Tx for more generalized oral lesions of primary infection is mostly palliative, using soothing mouth rinses and analgesics

Magic mouthwash:
Viscous lidocaine
Benadryl
Mylanta
Nystatin
Prednisone

Question 12

acute herpetic gingivostomatitis

Treatment (non-palliative)

Answer 12

Oral antivirals:
Acyclovir
Valacyclovir
Famcyclovir

Topical antivirals:
Acyclovir
Penciclovir

Question 13

Necrotizing Ulcerative Gingivitis

general
Offending pathogens

Answer 13

Infection with spirochetes AND fusiform bacilli
Common in young adults under stress (sound familiar?!); also seen in poor oral hygiene, patients with HIV/ immunocompromised
Smoking increases risk
Painful gingival inflammation and tissue death (necrosis)
Bleeding, halitosis, fever, cervical lymphadenopathy

Question 14

Necrotizing Ulcerative Gingivitis

Dx and Tx 4

Answer 14

Diagnosis is usually clinical; usually refer out for full diagnosis and treatment (periodontal specialist if possible)

Tx: warm chlorhexidine or diluted peroxide rinses PLUS antibiotics (metronidazole and PCN); will need to debride dead tissue if severe

Question 15

Oral candidiasis

General

Answer 15

opportunistic fungal infection
most common form in Candida albicans
mostly in immunocompromised ots, elderly and infants
30-50% of humans have C. albicans

also called Thrush, angular chilitis, median rhomboid glossitis, denture sore mouth, yeast infection.

can be acute, chronic, or mucocutaneous

Question 16

Candidiasis

Predisposing factors

Answer 16

Question 17

Candidiasis

classifications

Answer 17

Question 18

candidiasis

S/Sx

Answer 18

Small soft plaques
wiping away the plaques leaves a painful erythametous, eroded, or ulcerated surface.
if the plaques have not been disturbed, the associated sx are minimal.

found in buccal mucosa, mucobuccal folds, the oropharynx, and lateral aspects of the tongue.

Severe cases: pts may complain of tenderness, burning, and dysphagia.

Question 19

Acute erythametous candidiasis

general

Answer 19

generalized red lesion
caused by ABx Tx
Painful

ABx withdrawal will improve Sx

Question 20

Chronic erythametous candidiasis

(Denture stomatitis)

Answer 20

Question 21

Chronic erythametous candidiasis/ Denture stomatitis

Tx

Answer 21

remove dentures at night
clean dentures with strong antiseptic solution
good oral hygiene
peridex mouthwash

Question 22

Aphthous Stomatitis

causes

Answer 22

Question 23

Apthous Ulcers

Types

Answer 23

Question 24

Minor apthous ulcer

general

Answer 24

Question 25

# Minor apthous ulcer Tx Meds and diet(4)

Answer 25

topical steroid gel is most successful systemic steroid for 1 week oral rinse: Chlorohexidine dietary changes: folic acid, B12, iron, remove gluten reduction of oral lesion coincides with improvements in GI tract

Question 26

# Leukoplakia General

Answer 26

Question 27

# leukoplakia general | appearance, location, causes

Answer 27

Question 28

# leukoplakia Dx and Tx

Answer 28

Question 29

# Hairy leukoplakia general and Tx

Answer 29

Lateral border of tongue Common early finding in HIV but can also occur in organ transplant patients, EBV, long term corticosteroid use Like regular leukoplakia BUT a little thicker and appears hairy Treat with antivirals (acyclovir, famciclovir, valacyclovir) but only get temporary relief

Question 30

# Erythroplakia general

Answer 30

Similar to leukoplakia but it is erythematous in appearance 90% are dysplasia or carcinoma (“precancer” or cancer) DDx is basically anything that causes a change to the tongue (such as candidiasis, oral lichen planus, glossitis, etc) Biopsy

Question 31

# Oral Lichen Planus general and dx

Answer 31

“lacy” leukoplakia Erosive Chronic inflammatory autoimmune disease Must biopsy to diagnose and to be sure it isn’t squamous cell carcinoma

Question 32

# Oral Lichen Planus Tx

Answer 32

Treatment: manage pain- no cure and can’t really shorten length of episodes Medications: daily topical corticosteroids are 1st line, can try cyclosporine, retinoids and tacrolimus

Question 33

# Squamous Cell Carcinoma general

Answer 33

Question 34

# Squamous Cell carcinoma Tx

Answer 34

Surgical excision radiation/chemo successful Tx depends on the size, site, and stage of the lesion early detection is KEY!

Question 35

# Taste Salt

Answer 35

Salt receptors use a Na+ channel to sense the [Na+] in the mouth.

Question 36

# Tatse Sour

Answer 36

Sourness receptors respond to acidity (H+).

Question 37

# Taste Sweetness

Answer 37

Sweetness receptors use intracellular second messengers. (For example, binding of a sugar may stimulate formation of cyclic adenosine monophosphate (cAMP), which inhibits a K+ channel and depolarizes the receptor cell membrane.)

Question 38

# Taste bitterness

Answer 38

Bitterness receptors use more than one transduction mechanism, depending on the chemical. Mechanisms include direct binding to K+ channels and changes in second messengers.

Question 39

# taste Umami

Answer 39

Umami (Japanese word meaning “delicious”) receptors respond to amino acids, particularly glutamate.