oral cavity Flashcards
robbins
what is the etiology of dental caries
focal demineralization of enamel and dentin by acidic metabolites produced by bacteria
what is the most common cause of tooth loss before the age of 35
dental caries
name a protective factor against developing dental carie
fluoride in the water, incorporates into the enamel
inflammation of the oral mucosa= _____. this results from _______ and will lead to ________
gingivitis
poor oral hygiene
accumulation of dental plaque and calculus
what is a dental plaque
a biofilm that collects on and between teeth made of bacteria, salivary proteins, and desquamated epithelial cells
if a dental plaque is not removed, it will ____ to form a _____
mineralize, calculus
in what population is gingivitis most common
adolescence
describe trx and prognosis of gingivitis
its no big deal, just don’t eat that much sugar, floss and brush your teeth
it is reversible
what is the pathogenesis periodontitis
inflammation of periodontal ligaments, alveolar bone, and cementum
caused by poor oral hygiene, leading to change in oral flora
can eventually lead to the loss of teeth
describe the classes of organisms that cause periodontitis
in healthy gingival sites= G+ organisms
in active periodontitis, you start to get anaerobic and microaerophilic G- flora
what are the organisms primary associated with adult periodontitis
Actinobacillus actinomycetemcomitans
prophyromonas gingivalis
prevotella intermedia
what systemic conditions are associated with periodontitis
it can be a part of AIDS, leukemmia, Crohn’s, DM, Down Syndrome, sarcoidosis, chediak-higashi, neutropenia…
can cause infective endocarditis, pulmonary and brain abscesses
what is an aphthous ulcer
a canker sore=
recurrent, v painful, superficial, oral mucosal ulceration
what population is an aphthous ulcer associated with
very common, but most common in the first 2 decades of life
what systemic conditions are associated with aphthous ulcers
celiac
IBD
Behcet ds
‘single or multiple, shallow hyperemic ulcerations (of oral mucosa) covered by a thin exudeate and rimmed by a narrow zone of erythema’
aphthous ulcer
what is an irritation/traumatic fibroma
a submucosal nodular mass that primarily occurs on the buccal mucosa along the bite line or the gingiva
what is the treatment for an irritation/traumatic fibroma
complete surgical excision
what is a pyogenic granuloma
an inflammatory lesion typically found on the gingiva of children, YA, and pregnant women
=ulcerated, red-purple
“a highly vascular proliferation of organizing granulation tissue” “ulcerated, red to purple” in the oral mucosa
pyogenic granuloma
what is the prognosis and treatment of a pyogenic granuloma
can either regress, mature, or develop into an ossifying fibroma
definitive treatment is surgical repair
what is a peripheral ossifying fibroma
a common gingival growth that may arise from either
- a long standing pyogenic granuloma
- de novo from cells of the periodontal L
what population has the peak incidence for peripheral ossifying fibroma
young and teenage females
what is the treatment for peripheral ossifying fibroma
complete surgical excision down to the periosteum
in the gingiva an “aggregation of multinucleated, foreign body-like giant cells seperated by a fibroangiomatous stroma” “covered by intact gingival mucosa, may be ulcerated”
peripheral giant cell granuloma
what entity are most orofacial herpetic infections caused by
herpes simplex virus type 1 (HSV-1)
HSV-2 can occur but not as common
in what population do primary HSV-1 infections occur
children between 2 and 4 years of age
most adults harbor a latent infection
what is the prognosis of HSV-1 infections of the oral cavity
most are asymptomatic
but 10-20% can progress to acute herpetic gingivostomatitis with abrupt onset of vesicles and ulcerations of the mucosa, with lymphadenopathy, fever, anorexia..
describe the clinical presentation of recurrent herpetic stomatitis
-sx occur at the site of primary inoculation or adjacent mucosa associated with the same ganglion, groups of small vesicles on the lips, nasal orifice, buccal mucosa, gingiva, and hard palate
what is the common causative agent for mononucleosis, nasopharyngeal carcinoma, lymphoma
EBV
what is the common causative agent with herpangina, hand-foot-and-mouth disease, acute lymphonodular pharyngiti
enterovirus
what is the common causative agent of measles
rubeola
what is the most common fungal infection of the oral cavity
candida albicans
what factors influence the likelihood of someone being infected with candida
- immune status
- the strain of candida
- the individual’s normal oral flora
what is the most common clinical form of oral candidiasis
pseudomembranous aka thrush
as opposed to erythematous and hyperplastic
in oral cavity ‘superficial, gray to white inflammatory membrane made of organisms enmeshed in a fibrinosuppurative exudate that can be readily scraped off to reveal an underlying erythematous inflammatory base’
candida albicans
what are the oral changes associated with scarlet fever
raspberry tongue= fiery red with prominent papillae
strawberry tongue= white coated tongue through which hyperemic papillae project
what are the oral changes associated with measles
spotty enanthema in the oral cavity, preceding a skin rash
ulcerations on the buccal mucosa
koplik spots
what are the oral changes associated with infectious mono
acute pharyngitis and tonsillitis that can case a gray-white exudative membrane
enlargement of the LN in the neck
palatal petechiae
(EBV, associated with nasopharyngeal carcinoma)
what are the oral changes associated with diphteria
dirty white, fibrinosuppurative, tough, inflammatory membrane over the tonsils
what are the oral changes associated with HIV
changes with herpes, candida, kaposi sarcoma and hairy leukoplakia
what are the oral changes associated with lichen planus
reticulate, lacelike, white keratotic lesions that sometimes ulcerate and sometimes form bullae
what is a risk of abx that eliminate or alter the normal bacterial flora of the mouth
can result in candidiasis
what deep fungal infections have a predilection for the oral cavity
histoplasmosis blastomycosis coccidioidomycosis cryptococcosis zygomycosis (aka mucormycosis) aspergillosis
what is hairy leukoplakia
an oral lesion on the lateral border of the tongue caused by EBV usually seen in the immunocompromised
in what populations will you see hairy leukoplakia
the immunocompromised
AIDS and older people
“white, confluent patches of fluffy, hyperkeratotic thickenings” “balloon cells” in the upper spinous layer
hairy leukoplakia
how do you differentiate between candida and hairy leukoplakia
candida you can scrape off, hairy leukoplakia you can’t
both are white
a white patch or plaque that cannot be scraped off and cannot be characterized as any other disease
white patches/plaques that have sharply demarcated borders
leukoplakia
until proven otherwise, all leukoplakias must be considered _______
precancerous
“a red, velvety, possible eroded area.. remains level or slightly depressed” “almost always have severe dysplasia, CIS, or minimally invasive carcinoma” “subepithelial inflammation with vascular dilation”
erythroplakia
what is a speckled leukoerythroplakia
an intermediate form between leukoplakia and erythroplakia
in what population would you find leukoplakia and erythroplakia
male adults, mostly 40-70 y.o
what is the most common CA of the head and neck
squamous cell carcinoma (95% of them)
vascular neoplasms caused by _____ occur in AIDS patients
HHV8
in what population will you find oral cavity squamous cell carcinoma
middle aged people who’ve been chronic abusers of smoked tobacco and alcohol
growing in individuals younger than 40 (HPV subtype)
what are common risk factors for squamous cell carcinoma
tobacco and alcohol
eat paan or betel quid
actinic radiation (sun)
pipe smoking
as many as 70% of squamous cell carcinomas harbor oncogenic variants of ____, particularly ________
HPV:HPV 16
describe the prognosis of squamous cell carcinoma
classic early stage= 80% 5 year survival
late stage=20% 5 year survival
greater survival in HPV POSITIVE than HPV -
NOT DEPENDENT ON LEVEL OF DIFFERENTIATION IN CELLS
describe the significance of field cancerization in respect to squamous cell carcinoma
rate of second primary tumor in patients with squamous cell carcinoma is higher than any other malignancy
field cancerization postulates that multiple individual primary tumors develop independently in the upper aerodigestive tract as a result of chronic exposure to carcinogens
_____ ______ ______ are the most common cause of death in squamous cell carcinoma
second primary tumors
what are the frequent genetic mutations in squamous cell carcinoma
p63+ NOTCH1
overexpression of p16
inactivation of p53 and RB
describe the stages of squamous cell carcinoma
not a linear progresion
generally preceded by leuko/erythroplakia
early stages= raised, firm, pearly plaques or irregular, roughened or verrucous areas of mucosal thickening
can enlarge, and create ulcerated and protruding massess
may or may not progress to full thickness before invading the underlying connective tissue stroma
what are the most common sites of distant metastasis of squamous cell carcinoma
mediastinal LNs, lungs, liver, and bones
what are odontogenic cysts and where are they
=derived from remnants of odontogenic epithelim
present within the jaws
cyst in the teeth area = ‘thin layer of keratinzed stratified squamous epithelium with a prominent basal cell layer and a corrugated epithelial surface”
OKC/ keratocystic odontogenic tumor
in what population will you most likely see an OKC/keratocystic odontogenic tumor
between 10-40 y.o., most often a male with a posterior mandible
treatment for an OKC/keratocystic odontogenic tumor requires _________________ because they are _____ and ______ can reach up to 60%
complete removal of the lesion
locally aggressive
recurrence rates
patients with multiple OKCs/keratocystic odontogenic tumors should be evaluated for ____, which is associated with ______ located on _____
nevoid basal cell carcinoma syndrome (Gorlin syndrome)
mutations of the PTCH tumor suppressor gene
located on chromosome 9q22
an inflammatory cyst found at the apex of teeth
periapical cyst
what causes a periapical cyst and what can it result in
caused by advanced carious lesions/trauma
may result in necrosis of the pulpal tissue—> the cyst can exit into the surrounding alveolar base, causing the formation of a radicular cyst
what is the treatment of a periapical cyst
because they persist a long time with the presence of bacteria, trx requires the complete removal of the offending agent and appropriate restoration of the tooth or extraction
________ are derived from odontogenic epithelium, ectomesenchyme, or both
odontogenic tumors
the two most common and clinically significant odontogenic tumors
and whats the differnece between them
ameloblastoma= no ectomesenchymal differentiation
odontoma= most common= extensive depositions of enamel and dentin
what is the physical description of a mucocele
bluish in color, fluctuant and non tender mass
pseudocyst vs real cyst
real cyst as epithelium, pseudocyst no have it
inflammatory granulation tissue devoid of an epithelial lining
mucocele
where is the HSV virus stored in latent infection
trigeminal ganglion/ semilunar ganglion
“intra and intercellular edema with giant cells” Zank smear for cytopathic effect
HSV-1
highly vascular fungal infections, how do you differentiate between them
aspergillosis and mucorymycoses
1st is 90 degrees and septated
mucormycoses is not septated, can erode bone –> rhinocerebralmucormucoses (nose septum/cribiform up to the brain)
what fungus is shown by the india ink stain
cryptococcus
mononucleosis and blueberry muffin baby is caused by what?
CMV
purpura over the baby is blueberry muffin baby
what pathogen causes scarlet fever
strep pyogenes
dilantin/ phenytoin usage can lead to what
gingival hyperplasia
monocytic leukemia can result in
gingival hyperplasia
describe the presentation of HPV related SCC
ear ache, sore throat, odynophagia
because is farther back in the pharynx, uncommon in the oropharynx itself
