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GI II > Oral Cavity > Flashcards

Oral Cavity Flashcards

1
Q

Histology of Oral Cavity

A

Squamous Epithelium, Focally Keratinized

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2
Q

Pulp Chamber

A

Has nerve, pain receptors, capillaries, lymphatics, CT

When pulp is exposed to microbes, get inflammatory response

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3
Q

Cementum

A

Hydroxyapatite and collage at root
Anchors periodontal ligament to alveolar bone
Avascular

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4
Q

Periodontal ligament

A

“Multipotential cells”

Provides nutrients & vascularity for cementoblasts

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5
Q

Bacterial Succession

A

1st colonizers: S. mutans
2nd colonizers: Prevotella intermedia, Porphyromonas gingivalis
3rd colonizers: Actinomycetem comitans

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6
Q

Plaque and Micros

A

Micros that form the biofilm are mainly Strep mutans and anaerobes.
ECM contains proteins, long chain polysaccharides, and lipids

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7
Q

Dental Caries Pathologies

A
  1. Absorption of proteins + biofilm
  2. Secondary colonizers attach to primary colonizers
  3. Cells divid + form biofilm that hardens in 48hrs

Plaque+Lactic acid +Low pH –> dissolve Ca Phosphate of enamel

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8
Q

Caries Risk Factors

A

Sugar, processed foods, Xerostomia, meds, Sjogrens

Systemic risk of sepsis from flossing and brushing

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9
Q

Caries Complications

A

Fistula, Periosteal abscess, Radicular cyst
Cavernous sinus thrombosis
- internal carotid aa can become thrombosed and infected
- abducens n can be affected
- presents w/swollen eye, lateral gaze palsy, horizontal diplopia, headache
Ludwig’s angina - compromise airway

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10
Q

Gingiva & Periodontium

A

Plaque deposits beneath the gum line - gingivitis
Inflammation of gingiva is usually due to poor oral hygiene
Erythema, edema, bleeding, change in contour, soft tissue damage

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11
Q

Periodontitis

A

Can be due to poor oral hygiene due to genetics, diabetes, smoking, Ehlers-Dantos
Healthy periodontium - facultative gram positive organisms
Active periodontium w/plaque - anaerobic & microaerophilic gram negative flora
Adult periodontitis - Actinobacillus most common

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12
Q

Periodontal Disease

A

Mild - 1-3mm of attachment loss
Moderate - 4-5mm of loss
Severe - > 6mm of loss

Affects cementum, periodontal ligament and alveolar bone leading to loss of tooth

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13
Q

Periodontitis: Component of Systemic disease

A 
Acquired immunodeficiency syndrome (AIDS)
Leukemia
Diabetes mellitus
Sarcoidosis
Congenital
   - Kostmann’s Disease =
      Severe Congenital
       Neutropenia, deficient
       defensins and LL-37
   - Chediak-Higashi syndrome
agranulocytosis,cyclic neutropenia
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14
Q

Periodontitis: May cause Systemic disease

A

Infective endocarditis
Pulmonary abscess
Brain abscess
Adverse pregnancy outcome

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15
Q

Aphthous ulcer “canker sore”

A 
Painful ulceration of oral cavity mucosa.
Occur primarily in young adult
Not contagious
Very common aged 12-25 W>>M
Uncommon after 45
Rare assoc w/celiac or IBD
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16
Q

Initial HSV-1 Infection - Two Patterns

A

90% age 2 to 4 yr; asymptomatic or mild, transient orofacial blisters

10% Acute Herpetic Gingivostomatitis numerous variable-size mucosal ulcers

17
Q

Oral Candidiasis

A

~50 % healthy adults have Candida albicans in oral cavity

Risk for oral candidiasis: immunosuppressed (HIV, chemoRx, ect.) or newborn infants

Lesions: white, cheesy, “velvety”, easily scraped away with little or no bleeding

18
Q

Oral Hairy Leukoplakia

A

Two Factors: Immune Suppression (80% have HIV-1) + Epstein-Barr Virus (EBV)
Resembles ‘thrush’, but doesn’t scrape off
May be first sign of HIV
“balloon cells”

19
Q

(Black) Hairy Tongue

A

Condition of defective desquamation of the filiform papillae.
Basic defect in hairy tongue is a hypertrophy of filiform papillae on the dorsal surface of the tongue
Factors are numerous and include tobacco use and coffee or tea drinking

20
Q

Irritation Fibroma

A

Occur on tongue or buccal mucosa - bite line
Result of repetitive trauma
Reactive fibroblastic tissue
Treated by surgical excision

21
Q

Pyogenic Granuloma

A

Occur gingiva, tongue
Common in pregnancy (pregnancy tumor) and in children, young adults
Exuberant, Reactive granulation tissue

22
Q

Cancer of the Oral Cavity

A

95% are Squamous Cell Carcinomas; 5% are Adenocarcinomas of Salivary Glands

Oral Cavity…Usually Tobacco and Alcohol
- India-chewing betel quid & paan
- Subcategory < 40 yo…tongue…no risk factors
Oral Pharynx…70% HPV(usually Type 16)

23
Q

Leukoplakia = White Patch/Plaque

A

Cannot be scraped off; due to increased keratin

  1. Hyperkeratosis alone is NOT a premalignant change
  2. But, 5 - 25% leukoplakia do contain premalignant findings
  3. Biopsy is needed to evaluate if premalignant changes present
24
Q

Erythroplakia = Red Patch

A

Less common than leukoplakia, but more ominous …
represents highly vascular eroded mucosa …”
~ 90% have dysplasia or CIS, some have invasive SCC

25
Q

Oral Cavity/Oral Pharynx Squamous Cell Carcinoma

A

Invasive infiltrating squamous carcinoma with numerous “keratin pearls” and nests of malignant squamous cells.

26
Q

Staging and Treatment of Oral Cavity/Oral Pharynx SCC

A

Stage I – 2cm, 4cm or spread to one [3cm, spread to other tissues, or mets

Treatment:
Stage I-II: Wide local excision or RT
Stage III-IV: Excision + RT +/- chemo
HPV assoc tumors have better prognosis

27
Q

Mump (Infectious Parotitis)

A

Acute onset of bilateral tender, self-limited swelling of parotid or other salivary glands lasting 2+ days

Major complication: Testicular inflammation (orchitis) occurs ~40% of postpubertal males. Sequela may be sterility

28
Q

Sjögren Syndrome

A

9:1 F:M ratio; two peaks age of onset: Mid-20’s & Mid-50’s.

Mild disease (75%): Dry eyes and mouth (Sicca [dryness] syndrome) 
Dry mouth (Xerostomia) 
Severe disease (25%): Above, plus florid salivary gland enlargement, adenopathy
Extraglandular manifestations (vaginal dryness, joints)
Risk of non-Hodgkin's lymphoma (~5%)
29
Q

Sjögren Syndrome Dx

A

Antibodies - SS-A (Ro); SS-B (La)
Biopsy of lip minor salivary gland to get diagnosis
Defects of tubular function, including renal tubular acidosis, uricosuria, and phosphaturia, are often seen and are associated histologically with tubulointerstitial nephritis

30
Q

Mucocele (mucous retention cyst)

A

Most common lesion of salivary glands - may get bigger with meals
Cause: Blockage or rupture of minor salivary gland duct; leads to saliva blockage, pooling and distension.
Most frequent site is lower lip due to trauma

31
Q

Sialolithiasis

A

May result from blockage terminal portion of salivary duct by food particle [nidus] and subsequent enlargement of the nidus via aggregation of inspissated, dehydrated mucous
Common Location: submandibular; also in sublingual and parotid

32
Q

Bacterial Sialadenitis

A
  1. Duct obstruction leads to stasis…unilateral
  2. Stasis leads to bacterial infection, commonly Staph aureus and Strep viridans
  3. Bacteria cause acute inflammation (necrosis, suppuration abscess formation)
  4. Acute process continues leading to chronic inflammation that then causes gland destruction and fibrosis (scarring)
33
Q

Pleomorphic Adenoma (Mixed Tumor)

A

50% all salivary gland tumors and 70% of benign neoplasms

Location: 60% - parotid, 40% - submandibular/sublingual; rare - in minor salivary glands.

Painless, slow growing, mobile, discrete masses

Termed “Mixed Tumor” because both epithelial and mesenchymal (myxoid - cartilage) elements - neoplasm arises from multipotential basal myoepithelial cells

Carcinoma in pleomorphic adenoma: In 5-yrs , 2% develop carcinoma. In 15-yrs period, 10% of unresected pleomorphic adenomas will develop cancer.

34
Q

Warthin Tumor (Papillary Cystadenoma Lymphomatosum)

A

5 - 10% of all salivary tumors
parotid, M>F, 50s-60s, smokers
[possibly not even a neoplasm!]
Double layer of tall eosinophilic epithelial cells over a lymphoid stroma
Second most common salivary gland neoplasm

35
Q

Malignant Tumors of the Salivary GlandsMucoepidermoid Carcinoma

A

Parotid is the predominant site
[Parotid contains ~75% salivary tissue mass]
Slow-growing, but relentless:
difficult to excise and treat
Grade most important prognostically
Low-grade: locally aggressive, rarely metastasizes
>95% 5-yr and 10 year survival
High-grade: Invasive, frequent metastasis
<50% 5-yr survival
pink squamous cells -“epidermoid”
Mucin secreting

36
Q

Adenoid Cystic Carcinoma

A

Difficult to Treat
“Perineural invasion”
Tumor spreads via peripheral nerves with numerous “skip” or non-contiguous tumor extensions
50% mets to bone, liver, and brain, sometimes decades after attempted removal.
5-year survival rate 60% to 70%, it drops to about 30% at 10 years and 15% at 15 years.
Neoplasms arising in the minor salivary glands have poorer prognosis than those that arise in parotid glands.

GI II (5 decks)

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