Oral Cavitiy And Salivary Gland Disorders Flashcards
(23 cards)
What is the most common cause of tooth loss in people younger than 35?
Caries/cavities
- primary cause of formation is acid end products of sugar fermentation
Aphthous ulcers (canker sores)
Most common superficial mucosal ulcerations
- 40% of the population
Are most frequent in the 1st 2 decades of life and are both painful and often reoccur
- most cases spontaneously in 7-10 days
Cause is unknown, but there seems to be an association with
- celiac disease
- IBD
- Behcet disease
HSV infections of the oral cavity in children
Self-limiting primary infection of either HSV-1 or HSV-2
- most are HSV-1
- are reactivated often in times of compromised host immune system
- most arise between 2-4 yrs of age
10-20% of cases can manifest as acute hepatic gingivostomatitis (abrupt onset of vesicles and ulcerations throughout oral cavity during flair up)
recurrent herpetic stomatitis
“cold sores”
Are adult HSV-1 lesions that’s re asymptomatic and are self limiting with 7-10 days
- in immunocompromised individuals, can persist instead of being self-limiting
Factors associated with deactivation:
- exposure to UV lights
- extreme temps
- trauma
- allergies
- pregnancy/men’s traction
- upper respiratory tract infections
- immunosupression
*lesions appear at the site of primary inoculation along the mucosa of the infected ganglia (dermatome) *
Oral candidiasis (thrush)
Most common fungal infection of the oral cavity
- Candida albicans is the agent
Forms a pseudo-membrane
Of gray/white color that can be scraped off to reveal inflamed red tongue
Predisposing factors:
- immunosupression (#1)
- use of broad spectrum antibiotics
Fibromas
Submucosal nodular fibrous tissue masses that are formed in the presence of chronic irritation that results in CT hyperplasia
Most common site = buccal mucosa along the bite line
Treatment = surgical excision
Pyogenic granuloma
Inflammatory lesion typically found on the gingiva of children, young adults and pregnant women
- can be nicknamed “pregnancy tumor”*
- also can grow rapidly and mimic malignant neoplasms (they are not though)
Lesions are usually richly vascular and typically ulcerated with red/purple blood
Treatment = complete surgical excision
Leukoplakia vs erythroplakia
Leukoplakia
- “a white patch of plaque that CANT be scraped off and cannot be characterized clinically or pathologically as any other disease”
- seen in 3% of world population and can progress to SCCA (5-25%) (squamous cell carcinoma)
- is a disease of exclusion and is assumed cancerous until proven not
Erythroplakia
- “red, velvety sometimes eroded lesion that is flat or slightly depressed relative to surrounding mucosa”
- typically seen in males between 40-70 yrs old
- very high risk of malignant transformation (50%)
both are linked to tobacco use
Squamous cell carcinoma in the oral cavity
95% of cancers in the oral cavity
- very aggressive and is found more commonly in males
- develops from dysplastic precursor lesions
Overall survival rates = <50%
- also has high rates of developing new cancers (35%)*
- often shows “field cancerization” which shows multiple different tumors in the same area
What are the two pathways of developing SCC in the oropharynx
1) exposure to carcinogens
- smoking is #1 chronic alcohol #2
- frequent mutations involve TP53 and RAS
2) infections, especially HPV
- almost exclusively are seen in the tonsillar crypts or base of tongue
- HPV-16 is #1 subtype
- prognosis is better if they patient is this route rather than #1
What are the most common areas of SCC in the oral cavity
Floor of mouth
Lower lip
Soft palate
Gingiva
appear raised,firm pearly plaques as irregular roughened mucosal thickening
Morphology of SCC
Can be well differentiated neoplasms to anapalstic aggressive tumors
Most common site of metastasis is cervical lymph nodes, lungs, liver
Xerostomia
Dry mouth due to a decrease of production in saliva or increase clearance of saliva
Key factors:
- older than 70 yrs
- current sjogren syndrome
- radiation therapy
- anti-cholinergic side effects of medications
increases rates of dental caries and candidiasis as well as dysphagia
Sialadentitis
Inflammation of the salivary glands
- induced by trauma, viral/bacterial infection or autoimmune disease
most common form of viral = mumps
- most common inflammatory lesion = mucocele*
- blockage or rupture of salivary gland ducts
most common form of bacterial = staph. Aureus/ strep. Viridans
What is sialolithiasis
Salivary duct obstruction by stones/food debris or edema form injury
Pathogenesis of sjogren syndrome
Associated with HLA alleles and activation of autoreactive T-cells/B-cells
Targets the lacrimal and salivary primarily but can also hit exocrine glans in the GI/respiratory tracts and vagina
Sjogren syndrome histology
Earliest finding: periductal/perivascular lymphocytic infiltration
Later findings: atrophy acini, fibrosis, hyalinization and fat replacement
What is the most common type of cancer associated with sjogren syndrome?
B-cell lymphomas
Salivary gland neoplasms
Generally uncommon
65-80% of them arise within the parotid glans
- 10% = submandibular gland
15-30% of parotid gland cancers are malignant
40% of submandibular are malignant
70-90% of sublingual are malignant
the likelihood that a salivary gland tumor is malignant is inversely proportional to the size of the gland
Pleomorphic adenoma
Benign tumors that consist of epithelial and myoepithelial cells
- exhibit both epithelial and mesenchymal differentiation (mixed tumor)
60% of tumors in the parotid are pleomorphic adenoma
Characteristics:
- slow growing
- painless
- mobile discrete masses
Most aggressive malignant neoplasms of salivary glands
Treatment = complete excision (if not will regrow)
Mucoepidermoid carcinoma
Composed of variable mixtures of squamous cells, mucus secreting cells and intermediate cells
Represent 15% of all salivary gland tumors and occur mainly in the parotid glands
overall is the most common form of primary malignant tumor of the salivary glands
Clinical course and survival rates depend on the histology grade
- low-grade = 90% survival rates w/ 15% recurrence rates
- high-grade = 50% survival rates w/ 30% recurrence rates
Warthin tumor
A curious benign neoplasm that exclusively seen in the parotid gland
Occurs more often in males between 50-70
- *high incidence in smokers (8x)
Are benign and have a recurrence rates of 2% after resection (almost always cures)
Adenoid cystic carcinoma
A relatively uncommon tumor found in minor salivary glands
Are slow growing and unpredictable tumors
- have a strong tendency to invade perineural spaces and have the highest rates of recurrence
50% become metastatic and move to bone/liver/brain
- survival rates are 5yrs:60/70% ; 10yrs:30% ; 15yrs:15%
