Oral cavity triggers Flashcards
due to HSV 6
aphthous stomatitis
aka canker sore
stress as a major predisposing factor
aphthous stomatitis
aka canker sore
small ulceration with yellow-gray center that is painful. surrounded by red halos
aphthous stomatitis
aka canker sore
viscous lidocaine with topical steroids such as triamcinalone acetonide
aphthous stomatitis
aka canker sore
magic mouthwash
aphthous stomatitis
aka canker sore
tx options for aphthous stomatitis
Viscous lidocaine
Topical corticosteroids (triamcinolone)
Prednisone for 1 week if severe
Magic mouthwash
90% caused by HSV1 10% by HSV2
herpes gingivostomatitis (cold sore)
Can be caused by sunburn, oral trauma, stress or fever
herpes gingivostomatitis (cold sore)
small vesicles that rupture and form scabs that are associated with a burning sensation may present with CERCIVAL LAD
herpes gingivostomatitis (cold sore)
may present with cervical adenopathy, odynophagia, and drooling if severe
herpes gingivostomatitis (cold sore)
What are the three diagnostic options for herpes gingivostomatitis (cold sore)
- clinical (MC)
- PCR DNA test
- Tznack Smear (shows multinucleated giant cells)
acyclovir and valcyclovir as tx
herpes gingivostomatitis (cold sore)
also seen in hairy leukoplakia
common in infants, HIV patients, people undergoing chemo
oral candidiasis (thrush)
also seen in:
denture wearers
DM
immunocomp
peopel on abx or steroirds
common in denture wearers, DM, or people on steroids or ABX
oral candidiasis (thrush)
also seen in:
common in infants, HIV patients, people undergoing chemo
Creamy white patches that can be scraped off with a tongue depressor.
oral candidiasis (thrush)
presents with a painful and burning tongue
oral candidiasis (thrush)
also seen in Glossodynia
presents with beefy red tongue
oral candidiasis (thrush)
Dx with a wet prep with KOH
oral candidiasis (thrush)
in what diagnosis would you want to boil pacifiers and bottle nipples after use and also treat the mothers breasts if she is breast feeding
oral candidiasis (thrush)
treatment with nystatin or fluconazole
oral candidiasis (thrush)
note: nystatin is in magic mouthwash! so its actually used alot
best diagnostic tool for herpes gingivostomatitis
tznack smear
found in elderly d/t maceration and in children d/t thumb sucking/drooling/lick lipping
Angular cheilitis
MC in elderly!
what diagnosis commonly has a secondary candidal infection
angular cheilitis dueto candidiasis infecting the open wounds
treatment with clotrimazole or miconazole
angular cheilitis for the secondary candidal infection.
smooth surfaced tongue
glossitis
caused by nutritional deficiencies, drugs, dehydration
glossitis
also seen in:
autoimmune reactions
psoriasis
caused by irritants, psoriasis, possibly autoimmune reactions
glossitis
inflammation of the tongue that does NOT present with pain
glossitis
treated with empiric nutritional replacement therapy
glossitis
loss of filiform papillae on te tongue
glossitis
burning sensation in the mouth with no known cause
glossodynia
most common in post menopausal women
glossodynia without glossitis
no specific treatment known. but clonazepam, TCAs and behavioral therapy are often used.
glossodynia
white patchy lesion that cannot be scraped off of surface
leukoplakia
hyperkeratosis occuring in response to chronic irritation such as by dentures or tobacco
leukoplakia
can be a precursor to dysplasia or invasive squamous cell carcinoma
leukoplakia
also erythroplakia which are 90% either dysplasia or carcinomas
you must ALWAYS biopsy this oral disease if the patient reports a history of tobacco use?
why?
oral leukoplakia
to determine epithelial dysplasia or carcinomas
only treatment known is srugical removal
leukoplakia
erythroplakia too!
erythematous lesion(s) that can not be scraped off of the surface of the tongue
erythoplakia
bright red patch with sharp margins on the floor of the mouth
erythroplakia
powerpoint description:
Fiery red, sharply demarcated patch on the floor of the mouth, ventral tongue, or soft palate.
90% of these are dysplasia or carcinoma and therefore carry high risk for malignancy
erythroplakia
pt presents with the side of his tongue showing a raised area that has “peach fuzz” on it
hair leukoplakia
definition in powerpoint: Slightly raised, leukoplakic areas with a hair surface, often on the LATERAL aspects of the tongue.
commonly found in early HIV also is associated with EBV and long term steroid use
hairy leukoplakia
no treatment is technically needed. HAART can be used. valacyclovir and acyclovir show modest improvement
hair leukoplakia
also can use topical podophyllin
no treatment needed but can use topical podophyllin and antivirals
hairy leukoplakia
can also use HAART
pt presents with a reticular white rash on her tongue that she reports started a while ago and has spread. when the rash first started it was PAINLESS. it is now PAINFUL
lichen planus
powerpoint description:
usually asymptomatic, pain progresses as rash does. reticular or lacey patterns of white lines, papules or plaques.
there is no cure for this but can be treated with Clobetasol or triamcinolone (high potency topical steroids) 1st line
oral lichen planus
if severe treat with oral prednisone
a patient with a white rash on tongue reports she was treated with a topical steroid “clobetasol,” however her symptoms have since gotten worse. you determine her status is now severe, what do you treat her with
first of all this is oral lichen planus
oral prednisone 4-6 weeks
pt has a rash on her dorsal and lateral tongue with well demarcated areas that have “white scalloped” borders. when you go out to google what she has and come back, the rash has changed locations and pattern (creeeeeppppyyyyy and grooosss)
what does she have, how is it treated?
geographic tongue aka benign migratory glossitis
usually this is asymptomatic and there is no treatment necessary
an african american male who reports a pMHx of addison’s disease presents with “something wrong with my tongue”
on further questioning he reports a hx of depression which he takes antidepressants for and uses pepto-bismol frequently.
what is likely wrong with his tongue?
black tongue
MC in darker skinned people
can be caused by:
tetracycline, linezolid, antidepressants, pepto bismol, PPIs and addisons disease
retnetion of keratin on tips of filiform papillae
hairy tongue
due to smoking, poor oral hygiene, TEA OR COFFEE (thats us, rip)
what is it and how is it treated
hairy tongue.
tx: improve oral hygiene, smoking cessation, USE A TONGUE SCRAPER
seriosuly this is just so gross
calculus formation of a salivary duct
sialolithiasis
MC in Wharton’s duct
sialolithiasis
can also be seen in stensen’s duct which drains the parotid gland
elevated serum calcium can contribute to the development of this disease
sialolithiasis
precise reason unknown but tragnation of salivary flow and increased calcium contributes
pt presents with complaints of pain when she eats that worsens when she is done eating. she also reports she has had some swelling to the inside of her mouth
what does she have? how would you treat her?
sialolithiasis
sialogogues or sour candy or maybe PICKLLLLESSSS! to increase salivary secretion! crazy.
also could use heat, massage and hydration!
if super severe or large stone you either have to incise the duct to remove it or remove the duct entirely
CT is imaging of choice for diagnosis in this oral disease
sialolithiasis
MCC is staph Aureus
suppurative parotitis aka sialadenitis
also caused by anaerobes and is often polymicrobial
caused by mumps, flu, EBV, CMV
non-suppuratiev parotitis
caused by CF, Gout, tumors, DM or alcohoolism
non-infectious parotitis
seen in elderly postoperative pts who have been intubated or dehydrates
suppurative parotitis
also seen in :
recent intesnive teeth cleaning
anticholinergic use
malnutrition
ductal obstruction
malnutrition, anticholinergic use and intensive teeth cleaning are all causes of
suppurative parotitis
pt presents with unilateral face swelling that is worse after he eating. he also reports locking of the jaw and a fever of 100.9.
what does he have?
what will further PE and labs show?
he has suppurative parotitis
PE will show pus from opening of stensens duct w masssage
labs will show leukocytosis
imaging of choice is ultrasound or CT
suppurative parotitis
elevated serum amylase seen in which diagnosis
suppurative parotitis
needle aspiration and culture of material in which diagnosis
suppurative parotitis
tx for suppurative parotitis
- IV Nafcillin or 1st gen ceph PLUS metronidazole or clinda
if MRSA suspected use vanc
- once improvement is seen:
oral clinda PLUS cipro
OR augmentin alone - surgical I&D if no response after 48hrs of IV abx
can lead to respiratory obstruction, septicemia, and osteomyelitis.
complications of suppurative parotitis
bilateral swelling of the face that resolves within 5-10 days
non-suppurative parotitis
presents with redness and swelling of the submandibular gland that is tender.
sialadenitis
tx for sialadenitis
- IV Nafcillin or 1st gen ceph PLUS metronidazole or clinda
if MRSA suspected use vanc
- once improvement is seen:
oral clinda PLUS cipro
OR augmentin alone - surgical I&D if no response after 48hrs of IV abx
MCC is strep mutans
dental caries
flouride option for 6mo-16 years
oral drops, chewable tablets
flouride option for >6 years of age
lozenges
gel, paste or rinse
treatment for hypersensitive teeth
flouride varnish, also used for dental caries
risk factor includes sjogrens and radiation of the head and neck
dental caries
a patient with dental caries reports the pain has become more severe and persisitent, what has likely occurred?
the infection has spread to the pulp and caused pulpitis
on oral exam you find a spot on the gums above the canines that appears to contain pus. what is this?
dental abscess
presents with gingival edema and eryhema as well as themral hypersensitivity and sooth pain
sental abscess
treatment for small dental abscesses
PCN VK +/- metronidazole
PCN allergy = clindamycin
presents with bad breath, lymphadenopathy and fever
acute necrotizing ulcerative gingivitis
also presents with gum inflammation and ulceration.
note: halitosis = bad breath
metronidazole or clinda or augmentin as tx
acute necrotizing ulcerative gingivitis
also uses chlorihexadine rinses
chlorhexidine rinse
acute necrotizing ulcerative gingivitis
damages alveolar bone and periodontal ligaments
periodontitis
increases risk for preterm birth
periodontitis
when do you use PCN VK
dental abscess
Dry socket
this is considered a chronic inflammatory autoimmune disease of the mouth
oral lichen planus
