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Medicine I: HEENT > Oral and Mucosal Disease > Flashcards

Oral and Mucosal Disease Flashcards

1
Q

Causes of Dental Carries

A

Contributing factors:
Bacteria: S. mutans, lactobacillus, actinomyces (Produce acid, demineralize teeth)

Diet: Sugary, sticky foods, Frequency of sugar intake

Appearance of carious lesions:

  • -Chalky & white (early)
  • -Brown or black spots (later)
  • -Destruction of tooth tissue (cavity)
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2
Q

Most common teeth affected by dental carries:

A

Most common: Permanent 1st molars

“6 year molars”-present the longest

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3
Q

Caries Prevention:

A 
Fluoride!
Optimal oral hygiene
Floss 1x/day
Brush 2x/day with fluoridated toothpaste
Rinse 1x/day with fluoridated mouthwash (ACT)
Diet
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4
Q

Dental Abscess:

A

Acute inflammation (collection of neutrophils, aka pus) associated with a tooth, gum tissue or bone

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5
Q

Causes of Dental Abscesses:

A

Causes:
Most common: tooth decay extends into the pulp of the tooth infection spreads into the adjacent bone
Can also result from severe periodontal disease

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6
Q

Presentation of Dental Abscesses:

A

Initially presents as tenderness of tooth
Progresses to intense pain w/ sensitivity
May have headache, fever, chills, swelling, lymphadenopathy, drainage

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7
Q

Tx of Dental Abscesses:

A

Reduction & elimination of infection
Root canal treatment & restoration
Extraction
Incisional drainage if bone or soft tissue expansion

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8
Q

Prevention of Dental Abscesses:

A

Good oral hygiene
Regular dental visits
Seek treatment as soon as possible

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9
Q

Untreated Dental Abscesses:

A

Ludwig’s angina:
Extension of infection into soft tissues of floor of mouth and neck, results in airway compromise
……………..
Cavernous sinus thrombosis:
Extension to cause blood clot in the cavernous sinus of the brain

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10
Q

Gingivitis:

A

Inflammation of the gingiva without destruction of the underlying bone
Affects almost 100% of population by age 50
Reversible with optimal oral hygiene

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11
Q

Complications of Gingivitis:

A

If untreated, can progress to periodontitis

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12
Q

Gingivitis Presentation:

A

Red, inflamed gingiva that bleeds easily….

Gums may be swollen, tender or painful

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13
Q

Causes of Gingivitis:

A 
Poor oral hygiene
Hormonal influences
Immune dysfunction
Tooth crowding
Mouth breathing
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14
Q

Tx of Gingivitis:

A

Eliminate underlying causes

Professional cleanings

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15
Q

Drugs that commonly cause Hyperplastic Gingivitis:

A

Phenytoin (anticonvulsant)
Nifedipine (calcium channel blocker)
Cyclosporine (immunosuppressant)

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16
Q

Necrotizing Ulcerative Gingivitis

A 
AKA Vincent’s infection
Occurs with psychologic stress
Military service (trench mouth)
.........
Blunted with “punched-out” necrosis covered by gray pseudomembrane
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17
Q

Causes of Necrotizing Ulcerative Gingivitis:

A 
Several bacteria & possibly viruses
Other causative factors:
Immunosuppression
Smoking
Poor oral hygiene
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18
Q

Presentation of Necrotizing Ulcerative Gingivitis:

A

Swollen, necrotic gingiva
Fetid odor
Exquisite pain
Fever, lymphadenopathy, malaise

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19
Q

Tx of Necrotizing Ulcerative Gingivitis:

A

Debridement (dental cleaning)

Antibiotics, chlorhexidine

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20
Q

Complications of Necrotizing Ulcerative Gingivitis:

A

If untreated, disease can spread:
Necrotizing ulcerative periodontitis (bone)
Necrotizing ulcerative mucositis (oral soft tissue)
Cancrum oris (Noma) (skin)

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21
Q

Periodontitis

A

Inflammation of the periodontium (soft tissues and bone surrounding teeth)
Progressive loss of the bone -> tooth loss

Most common cause of tooth loss in patients older than 35

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22
Q

Risk factors of Periodontitis:

A 
Risk factors:
Advancing age
Smoking
Diabetes mellitus
Osteoporosis
HIV infection
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23
Q

Presentation of Periodontitis

A 
Blunting & apical positioning of gingival margins
“Long in the tooth”
Deep periodontal pockets 
Bone loss
Tooth mobility
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24
Q

Tx of Periodontitis:

A

Chronic Periodontitis:
Professional deep cleaning (scaling and root planing)
Improved oral hygiene
Severe cases the teeth may be non-salvageable and extraction is needed

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25
Q

Prevention of Periodontitis:

A

Control underlying disease
Professional cleanings
Improved home care

26
Q

Recurent aphthous ulcerations (RAU) :

A

AKA Canker sores

Most common oral mucosal pathoses

27
Q

Minor aphthous ulcerations:

A

Fewer recurrences & shorter duration
Occur almost exclusively on nonkeratinized mucosa

Yellow or white, removable membrane encircled by erythematous halo
1-5 lesions per episode
Heal without scarring within 2 weeks

28
Q

Major aphthous ulcerations:

A

Larger & more recurrences
Most common locations: Labial mucosa (inside of lips)

Deeper than the minor variant
smaller, 1-10 lesions per episode
Heals with scarring within 6 weeks

29
Q

Herpetiform aphthous ulcerations:

A

Greatest number of lesions & most recurrences
small, Up to 100 (may coalesce into larger ulcers)
Heal without scarring within 1 week

30
Q

Tx of recurrent aphthous ulcers:

A

Most patients need do NOT need treatment
OTC anesthetics or topical medicaments
Do NOT use silver nitrate

31
Q

Herpes Simplex Infection:

A

Causes: HSV-1& HSV-2

32
Q

Conditions linked to recurrent eruptions of herpes:

A 
Stress
Heat
Allergy
Trauma
Menstruation
33
Q

Primary HSV infection:

A

Abrupt onset with constitutional symptoms
Mild to severely debilitating
Produce lesions throughout mouth
Only time herpes lesions appear on movable mucosa in healthy patients
Numerous small vesicles; rapidly collapse to form numerous, small red lesions
Resolves within 2 weeks

34
Q

Recurrent HSV infection:

A

Prodromal signs 1 day before lesion develops
Most common site = lips (cold sore or herpes labialis)
Intraorally, only occurs on non-movable mucosa
Multiple, painful, erythematous, tiny papules develop & form clusters of fluid-filled vesicles
Resolves within 10 days

35
Q

Dx of Herpes:

A

If patient claims (s)he was infected with herpes in your office, perform IgG/IgM testing. Generally:
IgM in new cases
IgG in recurrent cases

36
Q

Tx of Herpes:

A

Treat with antivirals during primary herpetic infections to decrease recurrences

37
Q

Candidiasis:

A

Most common fungal infection in oral cavity

38
Q

Causes of Candidiasis:

A

Opportunistic fungal infection

C. albicans, part of the normal oral flora

39
Q

Presentation of Candidiasis:

A 
Variable clinical presentation:
Pseudomembranous 
Erythematous
Denture stomatitis
Angular cheilitis
Median rhomboid glossitits
40
Q

Pseudomembranous Candidiasis:

A

AKA “Thrush”
White, cottage-cheese like plaques that can be wiped off, leaving erythematous tissue

Patients may have burning or unpleasant taste

41
Q

Denture stomatitis:

A

Patients wear dentures 24 hours per day

Erythematous outline matches fit of denture

42
Q

Angular cheilitis:

A

Patients with no or old dentures that “overclose”
Saliva pooling at commissures of lips
Licking dry, cracked corners of mouth makes it very difficult to heal

43
Q

Median Rhomboid Glossitis:

A

Posterior midline of dorsal tongue

Symmetric loss of papilla which leaves a reddened, bald pattern

44
Q

Tx of Candidiasis:

A

Topical antifungals
Nystatin (high resistance): rinse, cream, or ointment
Clotrimazole or other “-azoles”: troches or cream

45
Q

Erythema Multiforme:

A

Blistering, ulcerative mucocutaneous condition

46
Q

Causes of Erythema Multiforme:

A 
Infection (herpes simplex, M. pnuemoniae)
Drug exposure (antibiotics or analgesics)
47
Q

Presentation of Erythema Multiforme:

A

Acute onset, may see fever, malaise, headache, cough, sore throat one week before onset
Skin lesions: erythematous target or bull’s eye shape lesions
Lips: hemorrhagic crusting of the vermillion border

48
Q

Severe Forms of Erythema Multiforme

A

Stevens-Johnson syndrome

Toxic epidermal necrolysis

49
Q

Treatment for Erythema Multiforme

A

Eliminate causative medication if possible
Viral trigger: can treat with Acyclovir
Supportive/Emergency medical treatment in severe cases
IV rehydration, IV immunoglobulins

50
Q

Lichen Planus

A

Chronic mucocutaneous disease
Lesions can appear on any mucosal surface (including genital areas) & skin
Cause: Immunologically mediated

51
Q

Triggering Factors of Lichen Planus:

A 
Triggering factors:
S - stress
T - trauma
A – Advil (*all NSAIDs)
Y – yeast (candidiasis)
52
Q

Reticular Lichen Planus

A

More common type
Asymptomatic

Presentation:
Wickham’s striae
Appears as white plaques on tongue
No ulcerations

53
Q

Erosive Lichen Planus

A

Less common
Symptomatic

Presentation:
Unilateral or bilateral ulcerations
Affects buccal mucosa, tongue or gingiva
Atrophic or ulcerated erythematous areas with surrounding border of white lines
Biopsy required to rule out other conditions

54
Q

Wickham’s striae:

A

Appears bilaterally on buccal mucosa as a “lace-like network of white lines”

55
Q

Tx of Lichen Planus:

A

Treatment:
Reticular- No treatment needed
Erosive- Topical corticosteroids

56
Q

Mucous Membrane Pemphigoid

A

Chronic, blistering, autoimmune disorder affecting mainly mucosal surfaces

Autoantibodies causes sub-epithelial separation

57
Q

Most common sites of Mucous Membrane Pemphigoid:

A

Lesions most common on gingiva
Vesicles or blood filled blisters
Blisters rupture leaving painful ulcerations
Most significant complication is ocular involvement in 25% of pts
Scarring eye lesions result in blindness in 10%

58
Q

Tx of Mucous Membrane Pemphigoid

A

Topical or systemic corticosteroids
Low dose antibiotics
Excellent oral hygiene

59
Q

Pemphigus Vulgaris

A

Autoimmune vesiculobullous disorder, usually affects the skin, may show oral mucosal involvement
Autoantibodies cause intraepithelial split

60
Q

Presentation of Pemphigus Vulgaris:

A

Oral lesions are typically the first sign

Superficial, ragged erosions & ulcerations throughout oral mucosa

61
Q

Tx of Pemphigus Vulgaris:

A

Systemic corticosteroids

62
Q

Complications of Pemphigus Vulgaris:

A

Before corticosteroid tx, 90% died due to infections & electrolyte imbalances
Now, mortality rate 5-10%, usually due to complications of long-term corticosteroids

Medicine I: HEENT (13 decks)

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