Oral Cavity - Exam 4 Flashcards
What is the scientific name for a canker sore? What is the cause? What virus is it associated with?
Aphthous Stomatitis
cause is unknown
stress is a major factor!!, trauma, hormones, immunodeficiency, emotional stress, celiac dz, IBD, maybe B12 def
herpes virus 6
Apthous stomatitis is found on ____ and ____ mucosa. Describe the sore. When is it supposed to heal
buccal or labial
**yellow-gray center surrounded by red halos
1-3 weeks pain lasts for 7-10 days
What is the tx for aphthous stomatitis? What if it is severe?
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
What do you do if apthous ulcer is very large or persistant?
If diagnosis not clear – incisional biopsy
What is Behcet’s disease?
is a rare disorder that causes blood vessel inflammation throughout your body. Including mouth sores, eye inflammation, skin rashes and lesions, genital sores
What are precipitating factors for Herpes Gingivostomatitis?
Oral trauma
Sunburn
Stress
Febrile illness
How does herpes gingivostomatitis present before the sore come out? What virus is it associated with? May have ______ present.
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
How is herpes gingivostomatitis dx?
clinical
PCR or culture
tzank smears
Which dx tool for herpes is more specific/sensitive? What will the Tzanck smear show if it is herpes?
PCR is more sensitive/specific than Tzank smear
Multinucleated giant cells
What is the tx for herpes gingivostomatitis? How soon do you need to start tx?
acyclovir or valacyclovir
must start within 24-48 hours
What organisms is oral candidiasis? What are some risk factors?
Candida albicans
young infants
dentures
DM
Immunocompromised pts (HIV!!!!)
chemo/radiation pts
abx
steroids
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?
Oral Candidiasis
clincial
**wet prep with KOH
budding yeasts with or without pseudohyphae
What is the tx for oral candidiasis? Pt is the important pt education point?
Nystatin swish and swallow
Flyconazole
Magic mouthwash
Continue use for 48 hours once symptoms resolve
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?
Angular Cheilitis
Candida albicans
What is the tx for angular cheilitis? What is the prevention?
Clotrimazole or Miconazole
Advise to stop licking lips
Recommend protective lip balm
If denture wearer – make sure dentures are properly fitted to prevent drooling
______ Inflammation of the tongue and loss of _____ results in a red, smooth surfaced tongue. Is it painful?
glossitis
filiform papillae
rarely painful
What is glossitis caused by? What is the tx?
Nutritional deficiencies
Iron, riboflavin, niacin, vitamin E
Drug reactions
Dehydration
Irritants
Foods and liquids
Possibly autoimmune reactions
Psoriasis
nutritional replacement
What is the cause of “burning mouth syndrome”? BMS without glossitis is MC in _____
no known cause
postmenopausal women
Burning Mouth Syndrome with glossitis is common in (name 5 conditions)
DM
Drugs
Diuretics
Tobacco use
Xerostomia
Candidiasis
What is the tx of Burning Mouth Syndrome?
No specific treatment (underlying cause)
clonazepam: works on GABA receptors, have on tongue
TCA’s
Behavioral therapy
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?
Leukoplakia
2-6% is dysplasic
bx to check for cancer in all pts with a hx of tobacco use
What is the tx for leukoplakia?
No known treatment to date that will reverse leukoplakia
surgically removal
advise pts to eliminate contributing factors: tobacco and alcohol
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?
Erythroplakia
~90% are either dysplasia or carcinoma
What is the tx for erythroplakia?
sx! surgical excision with clear margins
eliminate contributory factors: tobacco and alcohol
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?
hairy leukoplakia lateral portion of the tongue
commonly associated with HIV
no tx neccessary! need to adjust HAART therapy
oral lichen planus is caused by ??? Does it hurt?
Chronic inflammatory autoimmune disease
definitive cause is unknown
does NOT hurt
White lines, papules, or plaques
Reticular or lacey pattern
What am I?
How do you definitively dx?
oral lichen planus
bx
What is the tx for oral lichen planus? What is the tx for severe? What is the pt education?
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
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?
Geographic Tongue (Benign Migratory Glossitis)
no tx is necessary!
Hyperpigmentation of the tongue and oral mucosa
What am I?
What drugs commonly cause it?
What dz is it associated with?
black tongue
drugs: Tetracycline, Linezolid (Zyvox), Pepto-Bismol, Antidepressants, PPIs
dz: Addison’s dz
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/
Hairy tongue
smoking, coffee, tea, or poor oral hygiene
tx:
Improve oral hygiene
Smoking cessation
Tongue scrapers
What are the 3 salivary glands? What are the 3 salivary ducts?
Glands:
Parotid
sublingual
submandibular
Ducts:
Wharton’s duct
Stensen’s duct
Sublingual duct
What duct drains the submandibular gland? What duct drains the parotid gland? Which duct is MC to get blocked?
Wharton’s duct- MC
Stensen’s duct
What are some contributing factors to a sialolithiasis?
relative stagnation of salivary flow and elevated serum calcium concentration contributes (composed largely of calcium phosphate)
Postprandial Pain
Swelling
Spasm upon eating
What am I?
What is the diagnosis tool of choice?
What is the tx?
Sialolithiasis
CT
Local heat
Massage
Hydration
Small stone - salivary secretion first line
Sialogogues (Salagen, Evoxac)
Sour candy
What is the tx for a refractory sialolithiasis?
Incise duct remove stone
Sialendoscopy
Large stone – interventional removal of duct
_____ is inflammation of the parotid gland. **What is the MC organism of suppurative _____?
parotitis
suppurative MC: Staph Aureus, anaerobes is second
What is the MC cause of non-suppurative parotitis?
viral causes MC:
parainfluenza and EBV
What are some common pts who may present with suppurative parotitis?
Elderly postoperative patients who have been dehydrated or intubated
Recent intensive teeth cleaning
Medications that reduce salivary flow
Malnutrition
Ductal obstruction
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?
Suppurative parotitis
unilateral with pus from opening of Stensen’s duct
How do you dx suppurative parotitis?
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
What is the tx for suppurative parotitis?
**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
What do you do for suppurative parotitis if no improvement after 48 hours of IV abx?
Surgical I&D
Why is suppurative parotitis important to treat asap?
can progress to other parts of the neck
Swelling of the neck
Respiratory obstruction
Septicemia
Osteomyelitis of adjacent facial bone
Parapharyngeal space infection
Prodromal period followed by acute swelling
Often bilateral
resolves after 5-10 days
What am I?
What are the MC?
non-suppurative parotitis
parainfluenza and EBV
What is Sialadenitis? What is the MC organism?
Submandibular Gland inflammation
Staphylococcus Aureus
What is the dx TOC for sialadenitis? What is the tx?
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
_____ is the single MC chronic childhood dz? What is it caused by?
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
______ considered the primary strain causing dental caries
Streptococcus mutans
What are risk factors for dental caries in kids?
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
Demineralized areas
painless, opaque or brown spots
What am I?
Why is it need to be addressed?
dental caries
Cavity forms that can spread to and through the dentin and pulp
What is the management for dental caries? When do they need to see a dentist?
Patient education
Refer to dentist: By age 1
Prescribe fluoride as needed
Fluoride varnish
______ is a strong preventative measure for dental caries? What forms does it come in?
fluoride
Oral drops, chewable tablet, lozenges, gel, paste, oral rinse, fluoride varnish
What are some risk factors for adult dental caries?
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
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?
adult dental caries
pulpitis: infection spreads to the pulp
What is xerostomia?
Dry mouth resulting from reduced or absent saliva flow
Why are dental abscesses considered major?
possibility of spreading into deep neck structures causing airway obstruction
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?
dental abscess
**polymicrobial: Bacteroides, fusobacterium, Streptococcus Viridans
What is the tx for small dental abscess?
PCN VK treatment of choice +/- Metronidazole
If Penicillin allergic: Clindamycin
Analgesics
Chlorhexidine mouth rinses
dental referral
What is the tx for large dental abcesses?
I&D
+/- IV antibiotics
dental referral
What is gingivitis caused by?
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
How is gingivitis dx? what is the tx?
clinically!
Good oral hygiene practices
Tooth brushing
Flossing
What is the technical name for “Trench mouth” or “Vincent’s angina”? What is it caused by?
Acute Necrotizing Ulcerative Gingivitis
Caused by oral anaerobic fusiform bacteria and spirochetes
What is the tx for Acute Necrotizing Ulcerative Gingivitis?
Debridement
Metronidazole or
Clindamycin or
Augmentin
Warm, ½ strength peroxide rinses or Chlorhexidine rinses as adjunct
Painful, inflamed gingiva with ulcerations that bleed easily
Halitosis
Fever, malaise
Lymphadenopathy
What am I?
What are risk factors?
Acute Necrotizing Ulcerative Gingivitis
Poor oral hygiene
common in young adults under Stress
Tobacco, alcohol
_____ is the chronic inflammatory disease which includes gingivitis along with loss of connective tissue and bone support for the teeth. _____ and ____ are damaged
Periodontitis
alveolar bone and periodontal ligaments
______ is a major cause of tooth loss in adults and most common oral disease in adults
periodontitis
periodontitis and pregnancy increases your risk of _____. What pt population is at high risk?
preterm birth
homeless population is at high risk
what is periodontitis caused by?
Bacteria in dental plaque that create an inflammatory response
In gingival tissue
In soft tissue and bone supporting teeth
What are risk factors for periodontitis? What is it MC caused by? What is the management?
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
There is an association between poor oral health and ________
CV disease
______ usually occurs on the 2nd or 3rd post-op day. Severe oral pain. What is it caused by?
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
What are risk factors for a dry socket? What is the management?
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
