Oral Lesions, Odontogenic Infections, and Salivary Gland Disorders

Question 1

Histology of oral cavity

Answer 1

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

Question 2

Candidiasis
Hairy Leuko
Lichen planus

Answer 2

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

Question 3

Leukoplakia
Squamous cell
Geographic tongue

Answer 3

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

Question 4

Candidiasis

Answer 4

Can be wiped off

Tx with nystatin or clotrimazole

with dentures, may appear on ginviva

Question 5

Oral hairy leukpplakia

Answer 5

EBV

Dx can be confirmed with biopsy or EBV

Question 6

Lichen planus

Answer 6

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

Question 7

Squamous cell carcinonan

Answer 7

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

Question 8

Apthous ulcer
Primary herpes gingivostomatitis
Recurrent herpes gingivostomatits

Answer 8

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

Question 9

Herpangia
HFM dz
Stevens-johnson

Answer 9

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

Question 10

Recurrent apthous stomatitits

Answer 10

Canker sores

Tx is mostly sx pain relief with steroids or topical analgesics

Question 11

Herpes simplex gingibvostomatitis

Answer 11

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

Question 12

Enterovirus

Answer 12

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

Question 13

SJS

Answer 13

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

Question 14

Cytotoxic therapies

Answer 14

Mucositis - nonkeraottic skin surfaces and mouth soreness/burning sensation with acidic foods

Question 15

Osteonecrosis of the jaw

Answer 15

Ioninzigng radiation

Question 16

Denteoalveolar infection with path

Answer 16

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

Question 17

CM of denteoalveolar infections

Answer 17

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

Question 18

Mg of denteoalveolar infection and preventio

Answer 18

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

Question 19

Periodontal infection with path

Answer 19

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

Question 20

Periodontal CM and management

Answer 20

Red gums that bleed after eating or brushing

May become purple

Managmenet with chlorhexideine and remove tartar

Question 21

Comps of odontogenic and periodontal

Answer 21

Odonto - tooth loss…can disseminate into the blood as well

Perio - pregnancy preterm birth…Coronary and cerebrovascaulr dz

Question 22

Xerostomia

Answer 22

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

Question 23

Sialolithiasis

Answer 23

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,

Question 24

Sialadenitis

Answer 24

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

Question 25

Salivary gland tumors

Answer 25

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

Question 26

Progression of odonotgenic infections with sx

Answer 26

Initial is white

Extension to the pulp is temp sensitivie

Pulp infection - constant pain

Periapical abscess - gum swelling and apin with tapping

Question 27

Protective factors for odonotgenic

Pathogenic factors

Answer 27

Protective - fluoride inhibit bact metab, help minzeralization…xylitol dec cariogenic bacterai

Path - step mutans, lactobacillus