Oral Cavity and Salivary Glands Flashcards
Pathology of dental caries
focal demineralization of tooth by acidic metabolites of sugars produced by bacteria
Main cause of tooth loss before age 35
dental caries
Possible sxs of dental caries
pain, weight loss/nutrition problems, loss of self confidence, life-threatening infections
Causes of dental caries
poor oral hygiene, food with large amounts of carbs
What is gingivitis?
inflammation of oral mucosa surrounding the teeth due to poor oral hygiene, leading to the build up of plaque and calculus
What age group is gingivitis most common in?
adolescents
What is periodontitis?
Inflammatory process that affects structures of teeth, alveolar bone, and cementum
Oral bacteria associated with periodontitis
G- anaerobic microaerophilic
A. actinomycetemcomitans, P. gingivalis, P. intermedia
Systemic diseases associated with periodontitis
AIDS/HIV, leukemia, Crohn disease, diabetes, Down syndrome, sarcoidosis, defects in neutrophil
Inflammatory process
local reaction that shows up by swelling, heat, pain, and redness often due to infection, foreign body, immune rxns, tissue necrosis
Reactive process
showing a response to a stimulus such as hypoxia, chemical agents or drugs, infectious agents, immunologic reactions, genetic abnormalities, etc.
Aphthous ulcer
painful, superficial oral mucosal ulceration of unknown etiology
Aphthous ulcers are associated with what immunologic disorders?
Celiac disease, inflammatory bowel disease, Behcet disease
How quickly do aphthous ulcers resolve?
7 to 10 days
Traumatic fibroma description
submucosal nodular mass of fibrous CT stroma
Location of traumatic fibromas
bucal mucosa/bite line
Treatment of traumatic fibroma
surgical excision
Pyogenic granuloma description
inflammatory lesion on gingiva of children, young adults, and pregnant women
Morphology of pyogenic granuloma
ulcerated, red to purple; highly vascular proliferation
Peripheral ossifying fibroma description
gingival growth that may arise from a pyogenic granuloma or de novo from cells of periodontal ligament
Morphology of peripheral ossifying fibroma
red, ulcerated, nodular lesion of gingiva
Peak incidence of peripheral ossifying fibroma
young and teenage females
Torus palatinus
bony outgrowths with varied clinical appearance
How can microbes enter the oral cavity?
breaching epithelial surfaces, inhalation, ingestion, sexual transmission
What HSV type is responsible for oral herpetic infections
Typically HSV-1, but HSV-2 infections can occur
Morphological appearance of HSV infections
lesions of a few mm to large bullae, first filled with a clear fluid but can rupture to yield painful, red-rimmed, shallow ulcerations
Primary HSV infections typically occur in what population?
children between 2-4
Positive Tzanck Smear
acantholytic keratinocytes or multinucleated giant acantholytic keratinocytes are detected
HSV-1 clinical presentation
lymphadenopathy, fever, anorexia, irritability, painful vesicles and ulcerations of oral mucosa
Where does HSV take residence in the body?
sensory ganglia, especially trigeminal
Most common fungal infection of the oral cavity
candidiasis
Factors that influence clinical infection of candidiasis
strain of C. albicans, composition of oral flora, immune status of the patient
Leukocytes important for protection against Candida infections
Neutrophils, macrophages, Th17 cells
Morphological appearance of pseudomembranous Candida infections
superficial, gray to white inflammatory membrane composed of matted organisms enmeshed in a fibrinosuppurative exudate
Histological appearance of Candida species
pseudohyphae, budding yeast
Immunocompromised states that may predispose pts to Candida infections
AIDs, Chemo pts, transplant pts, DM, broad spec abx or steroid inhalers, pregnancy
Fungi with a predilection for oral cavity/head and neck
histoplasmosis, blastomycosis, coccidioidomycosis, aspergillosis, cryptococcosis, zygomycetes
Associated oral changes of scarlet fever
fiery red tongue with prominent papillae; white-coated tongue through which hyperemic papillae project
Associated oral changes of measles
Koplik spots on buccal mucosa (ulcerations
Associated oral changes of mono
gray-white exudative membrane, enlarged LN and palatal petechiae
Associated oral changes of diphtheria
dirty white, fibrinosuppurative, tough, inflammatory membrane over tonsils
Associated oral changes of HIV
predisposition to opportunistic infections; Kaposi sarcoma and leukoplakia
Hairy leukoplakia is caused by…
Epstein-Barr virus
Morphological description of hairy leukoplaxia
white, confluent patches of fluffy, hyperkeratotic thickenings typically situated on lateral border of tongue; cannot be wiped off, may have overlying candida infection that can be wiped off
Microscopic description of hairy leukoplakia
hyperkeratosis and acanthosis with “balloon cells” in upper spinous layer
Erythema multiforme
acute, self-limited condition associated with a type IV hypersensitivity rxn
Clinical description erythema multiforme minor
targets or raised, edematous papules distributed acrally
Clinical description erythema multiforme major
targets or raised, edematous papules distributed acrally with involvement of one or more mucous membranes; epidermal detachment involves <10% TBSA
SJS/TEN
widespread blisters on trunk and face, presenting with erythematous or pruritic macules and one or more mucous membrane erosions
Oral changes associated with pancytopenia and leukemia
severe oral infections, may extend to cellulitis of the neck
Oral changes associated with monocytic leukemia
leukemic infiltration and enlargement of gingivae, accompanying periodontitis
Oral changes associated with Peutz-Jeghers syndrome
polyps and dark-colored spots that appear on various parts of the body, increased risk for CA
Oral changes associated with phenytoin (dilantin) ingestion
fibrous enlargement of gingivae
Oral changes associated with Rendu-Osler-Weber syndrome
aneurysmal telangiectasias beneath mucosal surfaces of oral cavity and lips; autosomal dominant disorder that affects blood vessels and results in a tendency for bleeding
Multilocular keratocystic odontogenic tumor
Epithelial-lined cysts common in jaws
Population most commonly affected by keratocystic odontogenic tumors
males between ages of 10 and 40
Most common type of head and neck cancers
squamous cell carcinomas
5 Etiologies of SCC in head and neck
HPV, tobacco and alcohol, Betel quid and paan, actinic radiation and pipe smoking, and unknown causes without risk factors
Common HPV variant of SCC involving tonsils, tongue, pharynx
HPV-16
Population most common effected by HPV-associated cancers
white, non-smoking males 35-55
Cells of tonsillar epithelium first infected by HPV
basal keratinocyte progenitors, deep in tonsillar crypts
HPV viral genes associated with inactivation of P53 and RB pathways
E6 and E7
What protein is over-expressed in HPV induced SCC?
p16, which is a tumor suppressor protein encoded by CDKN2A
HPV-positive SCC prognosis
HPV-positive SCC has greater long-term survival than HPV-negative tumors
Clinical presentation of HPV SCC
sore throat, ear ache, odynophagia, weight loss, metastatic tumor in LN
Mutations in which pathways/proteins contribute to dysregulation of cell differentiation
p63, p53, and NOTCH1
Common genetic mutation acquired in progression of severe dysplasia
17p13
Percentage of leukoplakia cases that are precancerous
25%
Erythroplakia
red, velvety, possibly eroded area within oral cavity that usually remains level but may be slightly depressed; associated with severe dysplasia
Characteristics of dysplastic cells
loss of uniformity and orientation, pleomorphism, presence of mitotic figures
Proteins overexpressed in leukoplakia
Cyclin D1 and p63
5 year survival rate of early-stage SCC
80%
5 year survival rate of late-stage SCC
20%
Theory of field cancerization
multiple independent primary tumors develop as the result of years of chronic carcinogenic exposure
Xerostomia
“dry mouth” due to lack of saliva
Role of saliva
digestion, lubrication, protection
Medications associated with xerostomia
anticholinergic, antidepressant/antipsychotic, diuretic, antihypertensive, sedative, muscle relaxant, analgesic, antihistamine
Etiology of xerostomia
Sjögren syndrome, medications, radiation
Complications of dry mouth
increased incidence of dental caries, candidiasis, difficulty swallowing and speaking
Hypofunctioning of what portion of the nervous system may cause xerostomia?
parasympathetic nervous system
Etiologies of sialadenitis
trauma, autoimmune disease, viral, bacterial
Mucocele description
fluctuant fluid-filled lesion on lower lip subsequent to trauma causing rupture or blockage of salivary gland duct
Most common lesion of salivary glands
mucocele
Vaccines most often refused by parents
HPV, influenza, MMR
Population most commonly affected by benign salivary neoplasms
adults in fifth to seventh decades of life, slight female predominance
Population most commonly affected by malignant salivary neoplasms
adults in sixth to eighth decades of life, slight female predominance
Most common benign salivary neoplasms
pleomorphic adenoma, warthin tumor
Most common malignant salivary neoplasms
mucoepidermoid carcinoma, adenocarcinoma (NOS)
Presentation of a pleomorphic adenoma
well demarcated, painless, mobile, discrete mass
Malignancy potential of pleomorphic adenoma
can arise the longer they remain untreated
Gene rearrangement associated with pleomorphic adenomas
PLAG1 gene rearrangement, upregulates expression of genes that increase cell growth
Histologic features of pleomorphic adenomas
epithelial elements in ductal formations, acini, irregular tubules, strands, or sheets; mesenchymal foci of cartilage, bone, fat in myxoid stroma
Populations most at risk for developing warthin tumor
smokers, increased incidence in males
Histologic features of Warthin tumor
epithelial and lymphoid elements; cystic spaces separate lobules of neoplastic epithelial which consist of a double layer of eosinophilic epithelial cells based on a reactive lymphoid stroma
Most common primary malignancy of salivary glands
mucoepidermoid carcinoma
In what salivary glands do mucoepidermoid carcinomas most typically occur?
60-70% occur in the parotid glands
Mucoepidermoid carcinoma genetic aberration
t(11;19)(q21;p13) ; produces fusion gene product MECT1-MAML2
Mucoepidermoid carcinoma prognosis is dependent on…
grade of tumor, how abnormal cancer cells and tissues are
Typical location of adenoid cystic carcinoma
50% occur in minor salivary glands
Percentage of adenoid cystic carcinomas that disseminate
50%
Histologic features of mucoepidermoid carcinoma
grows in nests composed of squamous cells and clear vacuolated cells containing mucin
Histologic features of adenoid cystic carcinomas
cribriform pattern of tumor cells that enclose secretions; typically grow along nerves
