oral cavity Flashcards
genetic changes associated with “classic” head/neck SCC, and “HPV” head/neck SCC
classic:
P53 mutation
HPV:
p16 overexpression
E6 inactivation (p53)
E7 inactivation (RB)
oral manifestation of measles
-spotty oral ulcers preceding skin rash
-buccal ulcers about stensen duct (parotid duct)
(buccal ulcer = KOPLIK SPOTS)
____ is sticky colorless biofilm that collects between/on teeth made of bacteria, proteins, desquamated epithelial cells, and if untreated leads to ______, tartar
plaque —> calculus (mineralized plaque)
what are the 3 types of oral candidiasis
- psuedomembranous (thrush) *most common
- erythematous
- hyperplastic
define acute herpetic gingivostomatitis
children (2-4 yo) with HSV1/2 are usually asymptomatic, but if this disease presents with sx they are:
rapid onset of oral mucosa ulcerations and adenopathy with fever, anorexia, and irritability
inflammation of the oral mucosa (gums) around the teeth due to development of DENTAL PLAQUES and CALCULUS (and is reversible)
gingivitis
sx: red gums, edema, bleeding, mucosa contour changes
oral manifestation erythema multiform
-maculopapular, vesiculobullous, eruption
due to underlying infection, drug, cancer
inflammation affecting periodontal Ligaments (teeth support structures), alveolar bone, and cementum
periodontitis
oral manifestation diphtheria
dirty, white, fibrinosupprative, tough, inflammatory membrane over tonsils and retopharynx (throat)
{WHITE INFLAMMATORY MEMBRANE ON THROAT)
define odontogenic keratocyst (OKC)
including X-ray and histological characteristics
- aka keratocystic odontogenic tumor
- cysts derived from remnants of odontogenic epithelium within the jaw
- aggressive tumor
- x-ray: well defined locular radioluciences
- histo: thin layer of keratinized stratified squamous epithelium with prominent basal cell layer and corrugated epithelial surface
- tx: removal
very PAINFUL superficial oral mucosa ulcerations (recurrent and common) characterized by one or more hyperemic ulcers covered by thin exudate with red rim
apthous ulcers (canker sores)
- most common from 1-20 yo
- most resolve in 1 week unless immunocompromised
define recurrent herpetic gingivostomatitis
most adults harbor HSV 1 and get this dz.
- occurs at site of inoculation or in adjacent mucosa associated with same ganglion with dormant virus
- group of small vesicle lesions on lips (herpes labialis), nasal, cheek mucosa, and hard palate
- subside in 1 week or longer if immunocompromised
define pyogenic granuloma
[type of fibrous proliferative lesions]
- not pyogenic or granuloma**
- aka pregnancy tumor
- lobular capillary hemangioma that presents with ulcerated red-purple (NOT NODULAR) lesions on gingiva (gums)
- can progress to become dense fibrous masses or peripheral ossifying fibroma
- tx: removal
where does HSV 1/2 infection lay dormant
trigeminal (semilunar) ganglion
KEY sx assoc with deep fungal infections of oral cavity (esp mucormycosis)
-unilateral facial swelling, nasal/oral black lesions
more but less important sx: HA, fever, nasal congestion
benign painless bony outgrowth on the hard palate
torus palatinus
(type of oral extoses)
*grow due to genetics and environment
oral manifestation of scarlet fever
- raspberry tongue (red with prominent papillae)
- strawberry tongue (white with visible herpermic papillae)
(others: rash (impetigo) , sore throat, high fever,)
(cause is group A strep pyrogenes)
why is early detection important in head neck SCC
because 2nd primary tumor is most common cause of death in this type of SCC
benign bony growth in the mandible along surface near the tongue (in mouth)
torus mandibularis
(type of oral extoses)
*no cartilage
*grow due to genetics and environment
focal demineralization of tooth structure (enamel/dentin) by acid metabolites of bacteria produced fermented sugars
caries (tooth decay)
what are Hutchinson teeth and what pathology are they associated with
notched incisor teeth characteristic of congenital symphilis
what is the next step if multiple odontogenic keratocysts are seen in a patient
- must evaluate for Gorlin syndrome (nevoid basal cell carcinoma syndrome)
- associated with PTCH mutation on chr 9q22
“field cancerization: of head/neck SCC is associated with
cigarette smoking and repeated carcinogenic exposure
what pathogen is responsible for oral candidacies (thrush)
candida albicans
oral manifestation HIV
-increased risk of oppuruntistic infections
(HSV, Candida, Fungi)
-oral lesions of Kapoi Sarcoma
-hairy leukoplakia
three types of fibrous proliferative lesions of the oral cavity
- irritation fibroma
- pyogenic granuloma
- peripheral ossifying fibroma
* *tx for all is removal
define leukoplakia
white plaque that CANNOT be scraped off and CANNOT be tied to other dz
-precancerous lesion of squamous cell carcinoma
(*thrush CAN be scraped off and due to candida)
define peripheral ossifying fibroma
[type of fibrous prolifertive lesions]
- reactive lesion derived from pyogenic granuloma or denovo of periodontal L.
- present as red ulcerated NODULAR lesions of ginvgivia (gums)
- common in teenage girls
- tx: remove down to periosteum
biggest risk factors for lower lip cancers
pipe smoking and actinic radiation (sunlight)
COLON QUESTION
volcanic crypt eruptions is histo dx for what colonic pathogen
c. diff
pseudomembranes are not specific to only c. diff
oral manifestation of mono
- acute pharyngitis/tonsilittis with gray white exudative coat
- neck LN enlargement
- palatal petechiae
oral manifestation of SLE
-small PAINLESS oral/ nasopharyngeal ulcers
(others: butterfly rash, pancytopenia, arthralgia, nephritic syndrome)
[skin rash, joints, kidneys]
biggest risk factor of squamous cell carcinoma of head and neck
alcohol and tobacco use (others = - chewing betel quid and paan -actinic radiation (sunlight) -pipe smoking) *last two = lower lip cancers
define hairy leukoplakia
- oral lesions = white, confluent, fluffy patches of hyperkeratotitic thickenings
- oral lesion on LATERAL border of tongue
- HYPERPLASIA (not dysplasia as seen in NL leukoplakia and erythroplakia )
- seen in EBV infection of immunocompromised patients (esp HIV)
- microscopically= hyperkeratinosis, acanthosis, and “BALLOON CELLS” in upper spinous layer
normal healthy oral flora contains? unhealthy?
NL: facultative gram positive organisms
ABNL oral flora in plaque: anaerobic microaerophilic gram negative organisms
define the characteristics of HSV vesicles in recurrent herpetic gingivostomatitis
- have EOSINOPHILIC INTRANUCLEAR VIRAL INCLUSIONS
- have fusion cells that make MULTINUCLEATE POLKARYONS (giant cells)
- giant cells cause + Tzanck test
common bacterial pathogens that cause periodontitis
- PAP
- actinobacilius actinomycetemocomitans
- porphyromanos gingivalis
- prevotella intermedia
factors affecting risk fo oral candidiasis
immune status, strain of candida, composition of oral flora
describe the appearance of psuedomembranous oral candidiasis
gray white inflammatory membrane of organisms in fibrinosupprative exudate with underlying erythematous base
- *superficial infection unless immunocompromised (cancer pts, organ transplant pts, chemo tx pts)
- *THE MEMBRANE CAN BE SCRAPED OFF therefore distinguishable from leukoplakia
erythroplakia vs leukoplakia
more severe dysplasia and higher risk of malignant transformation in erythoplakia vs leukoplakia
*when both are present it is called speckled leukoerythroplakia
what organisms are responsible for deep in fungal infections of the oral cavity
- aspergillosis
- cryptococcis
- mucormycosis !!
predisposing RF: immunocompromised
-are highly vascular invasive
-sx: unilateral face swelling, nasal/mouth black lesions, HA fever, nasal congestion
population assoc with erythroplakia
40-70 yo male with hx of tobacco use
risk of squamous cell carcinoma of head and neck
define irritation fibroma
[type of fibrous proliferative lesion]
- aka trauma fibroma or focal fibrous hyperplasia
- submucosal nodular mass of fibrous connective tissue that most commonly occurs on the buccal (cheek) mucosa along the bite line
- tx: removal
define erythroplakia
red, velvety, possibly eroded areas of oral cavity that are usually level or slightly depressed
-precancerous lesion
(common in 40-70 men with hx of tobacco use)
complications, pathogenesis, and Risk factors associated with periodontitis
complication : teeth loss
pathogensis: poor oral hygiene + oral flora change
RF: neutrophil defect, Crohns, leukemia, AIDS, Down syndrome, Diabetes, sarcoidosis
(NC LADDS)
*can be component of systemic dz, or cause systemic dz (endocarditis, pulmonary or brain abscesses)
pathogen associated with squamous cell carcinoma of head and neck (esp tonsils, base of tongue, pharynx)
HPV-16
OROPHARYNX SCC
prognosis of head and neck SCC
if HPV + SCC then better long term survival vs “classic” SCC
(classic SCC = alcohol and tobacco assoc; NOT HPV assoc)
