Oral Facial Lecture Flashcards
What are some primary factors contributing to oral disease?
- smoking
- alcohol
- systemic dz = infections, DM, anemia, bowel dz, autoimmune dz
- medications (dexamethasone)
- stress/hormonal changes
- genetics
What is oral frictional hyperkeratosis?
-excessive growth of stubbornly attached keratin.
habit of cheek biting, chewing or tongue thrusting
what are some broad causes that may cause oral dz?
- local infection
- mucosal dermatologic changes
- halitosis
- pharmaceutical-induced changes
- systemic dz manifestations
- dental trauma
- Ca channel blockers (may cause swollen gums)
Examples of Local infections
- dental caries/acute pulpitis
- gingivitis/periodontitis
- dental abscess
- necrotizing periodontal dz (Vincents angina)
- Ludwigs angina
- fever blister or cold sores
- herpangina
- thrush
- hairy tongue
MC bacterial cause of dental caries?
streptococcus mutans
Dental Caries/Acute pulpitis
- sx
- prevention
- tx
- high risk population
Sx: hot/cold sensitivity, continuous throbbing pain
Prevention: flouride, brushing, flossing, mouthwash, routine cleanings
Tx: simple caries: restoration
Pulpitis: abx and NSAIDS, root canal may be necessary
High risk populations: chemotherapy, diabetics, xerostomia
Gingitivits/periodontis
- cause
- sx
cause: anaerobes
sx: usually painless, increased bleeding with brushing, soft tissue separation (pocket formation)
Periodontal abscess
- sx
- tx
- prevention
sx: edema, erythema, pyorrhea, pain
Tx: oral abx (PCN or clindamycin) and NSAIDS prn.
Prevention: good oral hygiene
Acute necrotizing ulcerative gingivitis
- aka
- sx
- tx
aka: vincents angina (Trench mouth)
- sx: halitosis, ulcerations of the interdental papillae
- Tx: PCN + metronidazole, clindamycin
Ludwigs Angina
- what this?
- sx
- tx
What: rapidly spreading cellulitis of sublingual and submandibular spaces. grape fruit under the jaw.
Sx: febrile, drooling, trismus, edema in Sublingual area spreading down the neck.
Tx: PCN or ampicilling/sulbactam (unasyn) plus metronidazole
Herpetic lesions
- presentation
- etiology
- tx
presentation: Cold sores or painful vesicles on tongue/buccal mucosa, white coated tongue, ulcerative gingivitis, lip and facial lesions.
etiology: HSV1 or 2
Tx: acyclovir or valacyclovir
Herpangina
- etiology
- sx
- tx
etiology: picornovirus specifically coxsackie virus
Sx: PAINFUL*, fever, malaise, sore throat, vesicles on the soft palate, last 7-10days
Tx: supportive (analgesics)
How long must lesions be present to be considered potentially cancerous?
2weeks
Oral Candidiasis
- etiology
- sx
- tx
etiology: candida sp from prolonged abx use, immunocompromised pts, and neonates.
sx: white plaques on tongue/oral mucosa, “burning tongue”, “raw throat”
Tx: topical fungal: clotrimazole or nystatin
oral: fluconazole (diflucan)
Hairy tongue
-what is this?
-elongation of filiform papillae, coloration of black hairy tongue is d/t tobacco, food, or infection with chromogenic organisms (MC fungi)
Aphthous stomatitis
- aka
- etiology
- management
Aka: canker sore
Etiology: autoimmune process, CMV, hormones, nutritional deficiencty (Vit B def)
Management: vit B12, stress relief, licorice, corticosteroids, folate, acidophilus, sucralfate
Geographic tongue
- sx
- pathophys
sx: asymptomatic
pathophys: rapid loss and regrowth of filiform papillae causes denuded red patches to “wander” across the surface of the tongue.
Oral leukoplakia
- pathophysiology
- sx
- tx
patho: benign epithelial hyperplasia (white growths along the side of the tongue)
sx: asymptomatic lesions on the lateral surfaces of the tongue
tx: acyclovir (zovirax)
Oral Cancer
-etiology
etiology: tobacco, ETOH use, HPV
Potential oral side effects of pharmaceuticals?
- xerostomia
- pigmentation changes
- hyperplasia
- mucositis
Causes of Halitosis
Lower resp infections: bronchiectasis, lung abscesses
oral infection: acute primary herpetic gingivostomatitis, acute nectrozing ulcerative gingivitis, periodontal dz, dental caries
smoking
hepatic failure (fishy)
azotemia (ammonia)
DKA
H. pylori gastric infection
esophageal cancer
metal poisoning (garlicky)
Xerostomia
- pharmological causes
- sx
- tx
cause: diuretics, drugs with anticholinergic effects (antihistamines, TCAs)
sx: oral dryness, burning of tissues, diff eating or swallowing, tongue irritation, painful ulceration, progressively increasing caries and periodontal dz
tx: saliva substitutes, salivary stimulation with sugarless hard candies …. biotiene may give some wetting of the mouth.
what do tetracyclines, sedatives, antimalarials, amalgam tattoo, oral birth control, and heavy metal pigmentation have in common?
-causes pigmentation changes of the gums, teeth, or tongue.
What medications cause gingival hyperplasia? tx?
- phenytoin, ca channel blocker, and cyclosporine
tx: surgical removal of the tissue is effective but hyperplasia recurs if drug is continued.
