Oral cavity triggers Flashcards by Billie Roberts

due to HSV 6

aphthous stomatitis

aka canker sore

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stress as a major predisposing factor

aphthous stomatitis

aka canker sore

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small ulceration with yellow-gray center that is painful. surrounded by red halos

aphthous stomatitis

aka canker sore

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viscous lidocaine with topical steroids such as triamcinalone acetonide

aphthous stomatitis

aka canker sore

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magic mouthwash

aphthous stomatitis

aka canker sore

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tx options for aphthous stomatitis

Viscous lidocaine
Topical corticosteroids (triamcinolone)
Prednisone for 1 week if severe
Magic mouthwash

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90% caused by HSV1 10% by HSV2

herpes gingivostomatitis (cold sore)

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Can be caused by sunburn, oral trauma, stress or fever

herpes gingivostomatitis (cold sore)

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small vesicles that rupture and form scabs that are associated with a burning sensation may present with CERCIVAL LAD

herpes gingivostomatitis (cold sore)

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may present with cervical adenopathy, odynophagia, and drooling if severe

herpes gingivostomatitis (cold sore)

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What are the three diagnostic options for herpes gingivostomatitis (cold sore)

clinical (MC)
PCR DNA test
Tznack Smear (shows multinucleated giant cells)

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acyclovir and valcyclovir as tx

herpes gingivostomatitis (cold sore)

also seen in hairy leukoplakia

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common in infants, HIV patients, people undergoing chemo

oral candidiasis (thrush)

also seen in:
denture wearers
DM
immunocomp
peopel on abx or steroirds

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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

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Creamy white patches that can be scraped off with a tongue depressor.

oral candidiasis (thrush)

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presents with a painful and burning tongue

oral candidiasis (thrush)

also seen in Glossodynia

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presents with beefy red tongue

oral candidiasis (thrush)

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Dx with a wet prep with KOH

oral candidiasis (thrush)

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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)

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treatment with nystatin or fluconazole

oral candidiasis (thrush)

note: nystatin is in magic mouthwash! so its actually used alot

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best diagnostic tool for herpes gingivostomatitis

tznack smear

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found in elderly d/t maceration and in children d/t thumb sucking/drooling/lick lipping

Angular cheilitis
MC in elderly!

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what diagnosis commonly has a secondary candidal infection

angular cheilitis dueto candidiasis infecting the open wounds

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treatment with clotrimazole or miconazole

angular cheilitis for the secondary candidal infection.

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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

1. IV Nafcillin or 1st gen ceph PLUS metronidazole or clinda if MRSA suspected use vanc 2. once improvement is seen: oral clinda PLUS cipro OR augmentin alone 3. 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

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