Oral and Mucosal Disease Flashcards
Causes of Dental Carries
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)
Most common teeth affected by dental carries:
Most common: Permanent 1st molars
“6 year molars”-present the longest
Caries Prevention:
Fluoride! Optimal oral hygiene Floss 1x/day Brush 2x/day with fluoridated toothpaste Rinse 1x/day with fluoridated mouthwash (ACT) Diet
Dental Abscess:
Acute inflammation (collection of neutrophils, aka pus) associated with a tooth, gum tissue or bone
Causes of Dental Abscesses:
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
Presentation of Dental Abscesses:
Initially presents as tenderness of tooth
Progresses to intense pain w/ sensitivity
May have headache, fever, chills, swelling, lymphadenopathy, drainage
Tx of Dental Abscesses:
Reduction & elimination of infection
Root canal treatment & restoration
Extraction
Incisional drainage if bone or soft tissue expansion
Prevention of Dental Abscesses:
Good oral hygiene
Regular dental visits
Seek treatment as soon as possible
Untreated Dental Abscesses:
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
Gingivitis:
Inflammation of the gingiva without destruction of the underlying bone
Affects almost 100% of population by age 50
Reversible with optimal oral hygiene
Complications of Gingivitis:
If untreated, can progress to periodontitis
Gingivitis Presentation:
Red, inflamed gingiva that bleeds easily….
Gums may be swollen, tender or painful
Causes of Gingivitis:
Poor oral hygiene Hormonal influences Immune dysfunction Tooth crowding Mouth breathing
Tx of Gingivitis:
Eliminate underlying causes
Professional cleanings
Drugs that commonly cause Hyperplastic Gingivitis:
Phenytoin (anticonvulsant)
Nifedipine (calcium channel blocker)
Cyclosporine (immunosuppressant)
Necrotizing Ulcerative Gingivitis
AKA Vincent’s infection Occurs with psychologic stress Military service (trench mouth) ......... Blunted with “punched-out” necrosis covered by gray pseudomembrane
Causes of Necrotizing Ulcerative Gingivitis:
Several bacteria & possibly viruses Other causative factors: Immunosuppression Smoking Poor oral hygiene
Presentation of Necrotizing Ulcerative Gingivitis:
Swollen, necrotic gingiva
Fetid odor
Exquisite pain
Fever, lymphadenopathy, malaise
Tx of Necrotizing Ulcerative Gingivitis:
Debridement (dental cleaning)
Antibiotics, chlorhexidine
Complications of Necrotizing Ulcerative Gingivitis:
If untreated, disease can spread:
Necrotizing ulcerative periodontitis (bone)
Necrotizing ulcerative mucositis (oral soft tissue)
Cancrum oris (Noma) (skin)
Periodontitis
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
Risk factors of Periodontitis:
Risk factors: Advancing age Smoking Diabetes mellitus Osteoporosis HIV infection
Presentation of Periodontitis
Blunting & apical positioning of gingival margins “Long in the tooth” Deep periodontal pockets Bone loss Tooth mobility
Tx of Periodontitis:
Chronic Periodontitis:
Professional deep cleaning (scaling and root planing)
Improved oral hygiene
Severe cases the teeth may be non-salvageable and extraction is needed
Prevention of Periodontitis:
Control underlying disease
Professional cleanings
Improved home care
Recurent aphthous ulcerations (RAU) :
AKA Canker sores
Most common oral mucosal pathoses
Minor aphthous ulcerations:
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
Major aphthous ulcerations:
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
Herpetiform aphthous ulcerations:
Greatest number of lesions & most recurrences
small, Up to 100 (may coalesce into larger ulcers)
Heal without scarring within 1 week
Tx of recurrent aphthous ulcers:
Most patients need do NOT need treatment
OTC anesthetics or topical medicaments
Do NOT use silver nitrate
Herpes Simplex Infection:
Causes: HSV-1& HSV-2
Conditions linked to recurrent eruptions of herpes:
Stress Heat Allergy Trauma Menstruation
Primary HSV infection:
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
Recurrent HSV infection:
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
Dx of Herpes:
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
Tx of Herpes:
Treat with antivirals during primary herpetic infections to decrease recurrences
Candidiasis:
Most common fungal infection in oral cavity
Causes of Candidiasis:
Opportunistic fungal infection
C. albicans, part of the normal oral flora
Presentation of Candidiasis:
Variable clinical presentation: Pseudomembranous Erythematous Denture stomatitis Angular cheilitis Median rhomboid glossitits
Pseudomembranous Candidiasis:
AKA “Thrush”
White, cottage-cheese like plaques that can be wiped off, leaving erythematous tissue
Patients may have burning or unpleasant taste
Denture stomatitis:
Patients wear dentures 24 hours per day
Erythematous outline matches fit of denture
Angular cheilitis:
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
Median Rhomboid Glossitis:
Posterior midline of dorsal tongue
Symmetric loss of papilla which leaves a reddened, bald pattern
Tx of Candidiasis:
Topical antifungals
Nystatin (high resistance): rinse, cream, or ointment
Clotrimazole or other “-azoles”: troches or cream
Erythema Multiforme:
Blistering, ulcerative mucocutaneous condition
Causes of Erythema Multiforme:
Infection (herpes simplex, M. pnuemoniae) Drug exposure (antibiotics or analgesics)
Presentation of Erythema Multiforme:
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
Severe Forms of Erythema Multiforme
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Treatment for Erythema Multiforme
Eliminate causative medication if possible
Viral trigger: can treat with Acyclovir
Supportive/Emergency medical treatment in severe cases
IV rehydration, IV immunoglobulins
Lichen Planus
Chronic mucocutaneous disease
Lesions can appear on any mucosal surface (including genital areas) & skin
Cause: Immunologically mediated
Triggering Factors of Lichen Planus:
Triggering factors: S - stress T - trauma A – Advil (*all NSAIDs) Y – yeast (candidiasis)
Reticular Lichen Planus
More common type
Asymptomatic
Presentation:
Wickham’s striae
Appears as white plaques on tongue
No ulcerations
Erosive Lichen Planus
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
Wickham’s striae:
Appears bilaterally on buccal mucosa as a “lace-like network of white lines”
Tx of Lichen Planus:
Treatment:
Reticular- No treatment needed
Erosive- Topical corticosteroids
Mucous Membrane Pemphigoid
Chronic, blistering, autoimmune disorder affecting mainly mucosal surfaces
Autoantibodies causes sub-epithelial separation
Most common sites of Mucous Membrane Pemphigoid:
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%
Tx of Mucous Membrane Pemphigoid
Topical or systemic corticosteroids
Low dose antibiotics
Excellent oral hygiene
Pemphigus Vulgaris
Autoimmune vesiculobullous disorder, usually affects the skin, may show oral mucosal involvement
Autoantibodies cause intraepithelial split
Presentation of Pemphigus Vulgaris:
Oral lesions are typically the first sign
Superficial, ragged erosions & ulcerations throughout oral mucosa
Tx of Pemphigus Vulgaris:
Systemic corticosteroids
Complications of Pemphigus Vulgaris:
Before corticosteroid tx, 90% died due to infections & electrolyte imbalances
Now, mortality rate 5-10%, usually due to complications of long-term corticosteroids
