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HEENT > Oral Cavity - Exam 4 > Flashcards

Oral Cavity - Exam 4 Flashcards

1
Q

What is the scientific name for a canker sore? What is the cause? What virus is it associated with?

A

Aphthous Stomatitis

cause is unknown
stress is a major factor!!, trauma, hormones, immunodeficiency, emotional stress, celiac dz, IBD, maybe B12 def

herpes virus 6

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2
Q

Apthous stomatitis is found on ____ and ____ mucosa. Describe the sore. When is it supposed to heal

A

buccal or labial

**yellow-gray center surrounded by red halos

1-3 weeks pain lasts for 7-10 days

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3
Q

What is the tx for aphthous stomatitis? What if it is severe?

A

no tx!! supportive care

can do viscous lidocaine, magic mouthwash, topical cortiosteroids

____

One week tapering course of prednisone if severe
40-60 mg/day, then taper

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4
Q

What do you do if apthous ulcer is very large or persistant?

A

If diagnosis not clear – incisional biopsy

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5
Q

What is Behcet’s disease?

A

is a rare disorder that causes blood vessel inflammation throughout your body. Including mouth sores, eye inflammation, skin rashes and lesions, genital sores

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6
Q

What are precipitating factors for Herpes Gingivostomatitis?

A

Oral trauma
Sunburn
Stress
Febrile illness

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7
Q

How does herpes gingivostomatitis present before the sore come out? What virus is it associated with? May have ______ present.

A

generally didn’t feel well 2-3 days before the sore appear, initial burning b4 cold core erupts

90% HSV 1, 10% HSV 2

cervical adenopathy

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8
Q

How is herpes gingivostomatitis dx?

A

clinical

PCR or culture

tzank smears

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9
Q

Which dx tool for herpes is more specific/sensitive? What will the Tzanck smear show if it is herpes?

A

PCR is more sensitive/specific than Tzank smear

Multinucleated giant cells

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10
Q

What is the tx for herpes gingivostomatitis? How soon do you need to start tx?

A

acyclovir or valacyclovir

must start within 24-48 hours

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11
Q

What organisms is oral candidiasis? What are some risk factors?

A

Candida albicans

young infants
dentures
DM
Immunocompromised pts (HIV!!!!)
chemo/radiation pts
abx
steroids

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12
Q

Painful, burning tongue
Creamy-white curd like patches overlying erythematous mucosa
Beefy red tongue
Can be scraped off the mucosal surface with tongue depressor

What am I?
How do you dx? What will it show?

A

Oral Candidiasis

clincial
**wet prep with KOH
budding yeasts with or without pseudohyphae

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13
Q

What is the tx for oral candidiasis? Pt is the important pt education point?

A

Nystatin swish and swallow
Flyconazole
Magic mouthwash

Continue use for 48 hours once symptoms resolve

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14
Q

Inflammatory lesion of the corner of the lips
Characterized by scaling and fissuring
dryness, itching, burning
Maceration is the usual predisposing factor

What am I?
What organism commonly invades the area?

A

Angular Cheilitis

Candida albicans

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15
Q

What is the tx for angular cheilitis? What is the prevention?

A

Clotrimazole or Miconazole

Advise to stop licking lips
Recommend protective lip balm
If denture wearer – make sure dentures are properly fitted to prevent drooling

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16
Q

______ Inflammation of the tongue and loss of _____ results in a red, smooth surfaced tongue. Is it painful?

A

glossitis

filiform papillae

rarely painful

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17
Q

What is glossitis caused by? What is the tx?

A

Nutritional deficiencies
Iron, riboflavin, niacin, vitamin E
Drug reactions
Dehydration
Irritants
Foods and liquids
Possibly autoimmune reactions
Psoriasis

nutritional replacement

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18
Q

What is the cause of “burning mouth syndrome”? BMS without glossitis is MC in _____

A

no known cause

postmenopausal women

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19
Q

Burning Mouth Syndrome with glossitis is common in (name 5 conditions)

A

DM
Drugs
Diuretics
Tobacco use
Xerostomia
Candidiasis

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20
Q

What is the tx of Burning Mouth Syndrome?

A

No specific treatment (underlying cause)

clonazepam: works on GABA receptors, have on tongue
TCA’s
Behavioral therapy

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21
Q

Hyperkeratosis occurring in response to chronic irritation
Dentures, tobacco, lichen planus, etc.
Presents as a white patchy lesion that cannot be scraped off the mucosal surface

What am I?
Is it normally cancerous?
What should you do if you see it?

A

Leukoplakia

2-6% is dysplasic

bx to check for cancer in all pts with a hx of tobacco use

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22
Q

What is the tx for leukoplakia?

A

No known treatment to date that will reverse leukoplakia

surgically removal

advise pts to eliminate contributing factors: tobacco and alcohol

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23
Q

Fiery red, sharply demarcated patch most commonly located on the floor of mouth, ventral tongue, or soft palate
generally found in older patients who consume tobacco and alcohol

What am I?
What am I at a high risk for?

A

Erythroplakia

~90% are either dysplasia or carcinoma

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24
Q

What is the tx for erythroplakia?

A

sx! surgical excision with clear margins

eliminate contributory factors: tobacco and alcohol

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25
Q

Slightly raised leukoplakic areas with a “hairy” surface occurring on the lateral portion of the tongue
Often develops quickly
waxes and wanes

What am I?
What is the MC pt population?
What is the tx?

A

hairy leukoplakia lateral portion of the tongue

commonly associated with HIV

no tx neccessary! need to adjust HAART therapy

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26
Q

oral lichen planus is caused by ??? Does it hurt?

A

Chronic inflammatory autoimmune disease

definitive cause is unknown

does NOT hurt

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27
Q

White lines, papules, or plaques
Reticular or lacey pattern

What am I?
How do you definitively dx?

A

oral lichen planus

bx

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28
Q

What is the tx for oral lichen planus? What is the tx for severe? What is the pt education?

A

no cure!

tx: topical steroids: Clobetasol
Triamcinolone topical 0.1% in Orabase

______________

**severe: oral steroids
prednisone 30-60mg daily for 4-6 weeks, then taper

Good oral hygiene
Smoking cessation

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29
Q

Well demarcated red areas of the dorsal and lateral tongue with white scalloped borders (edge/border with repeating patterns)
lesions can frequently change location, pattern and shape
Usually asymptomatic, but may have some discomfort or burning

What am I?
What is the tx?

A

Geographic Tongue (Benign Migratory Glossitis)

no tx is necessary!

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29
Q

Hyperpigmentation of the tongue and oral mucosa

What am I?
What drugs commonly cause it?
What dz is it associated with?

A

black tongue

drugs: Tetracycline, Linezolid (Zyvox), Pepto-Bismol, Antidepressants, PPIs

dz: Addison’s dz

30
Q

Retention of keratin on tips of filiform papillae
Seen on dorsal midline of tongue

What am I?
What are some common causes?
What is the tx/

A

Hairy tongue

smoking, coffee, tea, or poor oral hygiene

tx:
Improve oral hygiene
Smoking cessation
Tongue scrapers

31
Q

What are the 3 salivary glands? What are the 3 salivary ducts?

A

Glands:
Parotid
sublingual
submandibular

Ducts:
Wharton’s duct
Stensen’s duct
Sublingual duct

32
Q

What duct drains the submandibular gland? What duct drains the parotid gland? Which duct is MC to get blocked?

A

Wharton’s duct- MC

Stensen’s duct

33
Q

What are some contributing factors to a sialolithiasis?

A

relative stagnation of salivary flow and elevated serum calcium concentration contributes (composed largely of calcium phosphate)

34
Q

Postprandial Pain
Swelling
Spasm upon eating

What am I?
What is the diagnosis tool of choice?
What is the tx?

A

Sialolithiasis

CT

Local heat
Massage
Hydration
Small stone - salivary secretion first line
Sialogogues (Salagen, Evoxac)
Sour candy

35
Q

What is the tx for a refractory sialolithiasis?

A

Incise duct remove stone
Sialendoscopy
Large stone – interventional removal of duct

36
Q

_____ is inflammation of the parotid gland. **What is the MC organism of suppurative _____?

A

parotitis

suppurative MC: Staph Aureus, anaerobes is second

37
Q

What is the MC cause of non-suppurative parotitis?

A

viral causes MC:

parainfluenza and EBV

38
Q

What are some common pts who may present with suppurative parotitis?

A

Elderly postoperative patients who have been dehydrated or intubated

Recent intensive teeth cleaning

Medications that reduce salivary flow

Malnutrition

Ductal obstruction

39
Q

Acute swelling
Increased pain and swelling with meals
Trismus and dysphagia
Pus from opening of Stensen’s duct with massage
Fever and leukocytosis
Usually unilateral

What am I?
What is a key factor?

A

Suppurative parotitis

unilateral with pus from opening of Stensen’s duct

40
Q

How do you dx suppurative parotitis?

A

US, CT: looking for stone, abscess or tumor

can also be made clinically

Expression of purulent material from Stensen’s duct with gram stain and culture

Elevated serum amylase

41
Q

What is the tx for suppurative parotitis?

A

**IV abx:
Nafcillin or 1st generation Cephalosporin PLUS either Metronidazole or Clindamycin
Vancomycin or Linezolid (Zyvox) if MRSA suspected

can switch to oral abx when improvement

Clindamycin plus Ciprofloxacin
Or Amocicillin/Clavulanate Acid alone

42
Q

What do you do for suppurative parotitis if no improvement after 48 hours of IV abx?

A

Surgical I&D

43
Q

Why is suppurative parotitis important to treat asap?

A

can progress to other parts of the neck

Swelling of the neck
Respiratory obstruction
Septicemia
Osteomyelitis of adjacent facial bone
Parapharyngeal space infection

44
Q

Prodromal period followed by acute swelling
Often bilateral
resolves after 5-10 days

What am I?
What are the MC?

A

non-suppurative parotitis

parainfluenza and EBV

45
Q

What is Sialadenitis? What is the MC organism?

A

Submandibular Gland inflammation

Staphylococcus Aureus

46
Q

What is the dx TOC for sialadenitis? What is the tx?

A

CT

**IV abx:
Nafcillin or 1st generation Cephalosporin PLUS either Metronidazole or Clindamycin
Vancomycin or Linezolid (Zyvox) if MRSA suspected

can switch to oral abx when improvement

Clindamycin plus Ciprofloxacin
Or Amocicillin/Clavulanate Acid alone

hydration
warm compresses

I&D if abscess formation or refractory

47
Q

_____ is the single MC chronic childhood dz? What is it caused by?

A

Dental caries

Caused by demineralization of tooth enamel in the presence of sugar substrate and acid forming bacteria that are found in the soft gelatinous plaque

48
Q

______ considered the primary strain causing dental caries

A

Streptococcus mutans

49
Q

What are risk factors for dental caries in kids?

A

Repetitive use of a “sippy cup” containing sugars
Consumption of sticky foods
Sleeping with a bottle or nursing ad lib
Drinking non-fluoridated community water or bottled water
Low socioeconomic status
Medications that contain sugar or cause dryness

50
Q

Demineralized areas
painless, opaque or brown spots

What am I?
Why is it need to be addressed?

A

dental caries

Cavity forms that can spread to and through the dentin and pulp

51
Q

What is the management for dental caries? When do they need to see a dentist?

A

Patient education

Refer to dentist: By age 1

Prescribe fluoride as needed

Fluoride varnish

52
Q

______ is a strong preventative measure for dental caries? What forms does it come in?

A

fluoride

Oral drops, chewable tablet, lozenges, gel, paste, oral rinse, fluoride varnish

53
Q

What are some risk factors for adult dental caries?

A

Physical and medical disabilities
Presence of existing restorations or oral appliances
Patients with Sjogren’s syndrome
Medications that decrease saliva flow
Illicit drug use such as methamphetamine and cocaine
Radiation to the head and neck
Gingival recession
Low socioeconomic status

54
Q

Brownish discoloration
Non-localized pain upon exposure to heat or cold
results from activity of dental bacterial plaque

What am I?
What is it called when it spreads and pain is severe and persistent?

A

adult dental caries

pulpitis: infection spreads to the pulp

55
Q

What is xerostomia?

A

Dry mouth resulting from reduced or absent saliva flow

56
Q

Why are dental abscesses considered major?

A

possibility of spreading into deep neck structures causing airway obstruction

57
Q

an acute lesion characterized by localization of pus in the structures that surround the teeth
Dental pain
Toothache
Gingival Edema
Gingival Erythema
Discharge
Thermal hypersensitivity
Fluctuant mass
Trismus

What am I?
**What is the MC organism?

A

dental abscess

**polymicrobial: Bacteroides, fusobacterium, Streptococcus Viridans

58
Q

What is the tx for small dental abscess?

A

PCN VK treatment of choice +/- Metronidazole
If Penicillin allergic: Clindamycin
Analgesics
Chlorhexidine mouth rinses
dental referral

59
Q

What is the tx for large dental abcesses?

A

I&D
+/- IV antibiotics
dental referral

60
Q

What is gingivitis caused by?

A

inflammatory process that occurs as the result of prolonged exposure of the gingival tissues to plaque

also could be due to steroids, calcium channel blockers, phenytoin, cyclosporine

61
Q

How is gingivitis dx? what is the tx?

A

clinically!

Good oral hygiene practices
Tooth brushing
Flossing

62
Q

What is the technical name for “Trench mouth” or “Vincent’s angina”? What is it caused by?

A

Acute Necrotizing Ulcerative Gingivitis

Caused by oral anaerobic fusiform bacteria and spirochetes

63
Q

What is the tx for Acute Necrotizing Ulcerative Gingivitis?

A

Debridement
Metronidazole or
Clindamycin or
Augmentin
Warm, ½ strength peroxide rinses or Chlorhexidine rinses as adjunct

64
Q

Painful, inflamed gingiva with ulcerations that bleed easily
Halitosis
Fever, malaise
Lymphadenopathy

What am I?
What are risk factors?

A

Acute Necrotizing Ulcerative Gingivitis

Poor oral hygiene
common in young adults under Stress
Tobacco, alcohol

65
Q

_____ is the chronic inflammatory disease which includes gingivitis along with loss of connective tissue and bone support for the teeth. _____ and ____ are damaged

A

Periodontitis

alveolar bone and periodontal ligaments

66
Q

______ is a major cause of tooth loss in adults and most common oral disease in adults

A

periodontitis

67
Q

periodontitis and pregnancy increases your risk of _____. What pt population is at high risk?

A

preterm birth

homeless population is at high risk

68
Q

what is periodontitis caused by?

A

Bacteria in dental plaque that create an inflammatory response
In gingival tissue
In soft tissue and bone supporting teeth

69
Q

What are risk factors for periodontitis? What is it MC caused by? What is the management?

A

Poor oral hygiene
Smoking
Environmental factors – crowded teeth, mouth breathing
Comorbid conditions
Low socioeconomic status
***Most common induced by plaque

Patient education - good oral hygiene
Refer to dentist

70
Q

There is an association between poor oral health and ________

A

CV disease

71
Q

______ usually occurs on the 2nd or 3rd post-op day. Severe oral pain. What is it caused by?

A

Dry Socket
Post extraction Alveolar Osteitis

Displacement of the clot or fibrinolytic dissolution of the clot results in exposure of the alveolar bone and initiates a localized osteomyelitis of the exposed bone

72
Q

What are risk factors for a dry socket? What is the management?

A

Smoking
Preexisting periodontal disease
Traumatic extraction
Prior history of alveolar osteitis
HRT

Refer to dentist!!
Dental radiographs to exclude FB
Local or topical anesthesia
Irrigation of dental socket, suction, medicated packing
Penicillin VK or clindamycin

73
Q
A

HEENT (12 decks)

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