Oral Lesions, Odontogenic Infections, and Salivary Gland Disorders Flashcards
Histology of oral cavity
Keratinized in the hard palate and gums
Non keratinized in lining mucosa of the soft palate, buccal mucosa and floor
Lips is transition from oral cavity to external as inner lip is non but out is
Candidiasis
Hairy Leuko
Lichen planus
C. albicans…young infants, dentures, AB use, immunodef…yellowish white plaques that WILL scarpe off tongue blade…tongue and buccal mucosa
EBV…HIV…Homogenous raised white patch…lateral tongue
Chronic inflamm autoimmune dz…middle aged adults, associated with foods, amalgam, meds….white lines or plaques in a lacy pattern…erythematous anderosive on buccal musoca
Leukoplakia
Squamous cell
Geographic tongue
Premalig epithelial hyperplasia to dysplasia…adults associated with tobacco..heterogenous raised white plauqe with erythroleyukoplakia on tongue/buccal
Malig trnaosfmraiton of squamous epitherlium…adults with tobacco or alcohol or immuno…same as leukoplakia but ulcerates…on tongue and buccal mucosa
Benigng migratory glossitis resulting in loss of fliliform papillae…red patches with white polycylci borders that change size on dorsal tongue
Candidiasis
Can be wiped off
Tx with nystatin or clotrimazole
with dentures, may appear on ginviva
Oral hairy leukpplakia
EBV
Dx can be confirmed with biopsy or EBV
Lichen planus
Primary T cell mediated against epithelial basal cells
Most commonly reticular form but could also be hyperkeratotic plaqyues
Dx is based on presentation but could get biopsy
Squamous cell carcinonan
HPV can also cause
Most develop from leukoplakia
LAD is suggestive as most spread here
Neurologic sx may occur as well
Fine needle aspiration is first step…can get imaging studies
Get radiation or surgical resection
Apthous ulcer
Primary herpes gingivostomatitis
Recurrent herpes gingivostomatits
CMI dysregulation…children and young adults associated with stress…small and round painful that heal on the buccal mucosa
Children under 5…multiple intraoral vesicular lesions on erythematous bassed…buccal and givinga
Latent reactivation…adults and adolescents precip by sunlight, trauma, emotional stress…pain and burning prodrome on lip and perioral skin
Herpangia
HFM dz
Stevens-johnson
enterovirus…3-10 y/o…painful on the soft palate and uvula with abrupt fever onset
Same but painful on the tongue and buccal mucosa and rash on hands and feet
CM cytotoxic rxn against keratinocytes…any age with meds/infections…painful hemorrhagic erosions on the lips and buccal mucosa
Recurrent apthous stomatitits
Canker sores
Tx is mostly sx pain relief with steroids or topical analgesics
Herpes simplex gingibvostomatitis
Primary infection is asx
Could have systemic sx
Reucrrent is restricted to keratiznied
Dx can be with herpex simplex in vesicle fluid
Administration of antibirals early…sx pain relief with NSIADs and topicals
Enterovirus
Coxsackievirus A6, A16, and entero A71 associated with most outbreaks of herpangina and HFM
Dx based on clinical features but can do a PCR…managmeenet is typically NSAIDs and topicals
SJS
Sulfonamide, allopurinol, anticonvulsants…mycoplasma pneummonia
1-3 prodrome of fever, myalgia, arthralgia
Cutaneous lesions predominate with skin sloughing
Dx based on clinical ]
Mostly supportive care
Cytotoxic therapies
Mucositis - nonkeraottic skin surfaces and mouth soreness/burning sensation with acidic foods
Osteonecrosis of the jaw
Ioninzigng radiation
Denteoalveolar infection with path
Destruction of hard tissues by plaque bacteria…may move from enamel and dentin to pulp cavity itself
Enamal is mostly calcium salts while dentin is mostly hydroxyapatite
Dentin found in crown and root while enamel in the crown
Cementum is calcief but not as resistant to infection
Infections from the polques…mutans converts carbs to lactic acid which dissolves calcium phosphate and demineralizes the enamel and dentin…bacteria then gain access to pulp cavity…inflam response can compress BV and lead to necrosis
CM of denteoalveolar infections
White spot on tooth surface form decalcification of enamel…if spread to dnetin, then light brown
Sx associated with infectvion of the pulp…tootache with cold drinks
Periapical abscess if gum swelling and pain with tapping of the tooth
Mg of denteoalveolar infection and preventio
Removal of softerned and hard tissue follwoed by rest therapy and preven
Ealry pulpitis tx same but once ischemia develop,s need to tx aggressively
Root canal
Periapical abscess with analgesics and ABs
Prevention - salivary flow to prevent bacterial proliferation
Fermentable carbs at tooth surface subbly substrate for lactic acid
Avoiding sufgar also helps
Periodontal infection with path
Gingiva surrounds each tooth extending down over alveolar bone
Plaque beneath ginvgival margin can exposre to bacteria
This is mostly anaerobic
Inflammation worse with presence of tartar
Periodontal CM and management
Red gums that bleed after eating or brushing
May become purple
Managmenet with chlorhexideine and remove tartar
Comps of odontogenic and periodontal
Odonto - tooth loss…can disseminate into the blood as well
Perio - pregnancy preterm birth…Coronary and cerebrovascaulr dz
Xerostomia
Dry mouth
Meds are #1 - anticholinergics, B block, CCBs, diuretics
Sjogrens, chonric sialadenitis
DM, HIV
Head or neck radiation
Age dz of glandular acinar cells
Managment is eliminating meds and supplemntaing things to help
Can give muscarininc agent lile pilocarpine or cevimeline to inc salivary flow
Sialolithiasis
Calculi or stone within salviary glands - mostly in submandib
Calcium phosphate
Swelling that owrsens with eating due to stretch receptors
Palpation of duct openings - whartons on floor of mouth or Stensens on buccal mucosa
Mg - supportive care, hydration, moist heat,
Sialadenitis
Acute inflmation of salivary glands
Mumps, entero, influenza, HIV
Staph aureus, anearbocvi
Sjogrrns
Radiation
Main manifestation is painful swelling
Bacterial if pain swelling and inability to open the mouth
Tenderness over the gland and discahrge from the opening of the duct
Mg is conservative but if bacterial, give augmentin or combo of nafcillin and metronidazole or clinda
Salivary gland tumors
Benign tumors - firm and slow growing in the parotid gland
Malig - grow quickly and may involve facial nerve and spread to regional LNs
Need a biopsy to distinguish between pleomorphic ademona (of parotid) and malignant
Pleomorphic adenoma may recur after resection
Progression of odonotgenic infections with sx
Initial is white
Extension to the pulp is temp sensitivie
Pulp infection - constant pain
Periapical abscess - gum swelling and apin with tapping
Protective factors for odonotgenic
Pathogenic factors
Protective - fluoride inhibit bact metab, help minzeralization…xylitol dec cariogenic bacterai
Path - step mutans, lactobacillus
