Oral Medicine Flashcards
Outline the relevent anatomy of the tooth. What makes up the peridontium? What makes up the attachment aparatus?
What is the other name of baby teeth? (I just thought this was funny tbh)
When do you start getting baby teeth? When should you be done?
When do you start getting permanent teeth? When should you be done?
Decisious dentition
First tooth central lower inscisor around 6 months
Should have all your baby teeth by 3
Permanent teeth come in age 6 starting with first molar, second molar 13, wisdom teeth 18
What are the names of the teeth in order?
Central inscisor
Lateral inscisor
Canine
Two premolar or bicupsid
Three molars or tricupsid
What are the different sides of teeth?
Facial (to face) and oral (to inside of mouth)
Mesial (to midline) and distal (to mandible)
interproximal (between teeth) and occlusal (where you bite)
Apical (to root), coronal is to crown
How does tooth decay actually work?
Bacteria eat food left on teeth
Then they generate acid as by product of metabolism
The acid demineralizes the enamel
Once it gets into the dentin its poruous and sends bacteria to pulp
Pulp becomes inflamed (pulpitis)
Eventually pulpitis becomes irreversible
What are the physcial exam findings of pulpitis and what they represent?
Reversible will be sensitive to tempurature or pressure
Irreversible will just hurt with no stimuli
Exquisite pain with percussion suggests peri-apical abscess
Define the following:
Periodontitis
Acute necrotizing ulcerative gingivitis (trench mouth)
Necrotizing peridontitis
Necrotizing stomatitis
Vincent Angina
Noma
periodontitis - inflammation of the supporting structures of the teeth such as the gums, the alveolar bone, the cementum and the periodontal ligament
trench mouth is also known as acute necrotizing ulcerative gingivitis which involves only the gingiva
necrotizing periodontitis if it’s the attachment apparatus plus the gingiva
necrotizing stomatitis if the disease extends into the surrounding oral mucosa
Vincent angina is infraction that further involves the tonsils and pharynx
Noma the most diffuse necrotizing disease also referred to as cancrum oris or fuspirochetal gangrene or the entire mouth is involved and is often fatal
What is the management of the spectrum of gingivitis and periodontal disease?
Twice daily flossing and brushing
Stop smoking
NSAIDs as needed
Chlorohexadine rinses
If reasonable follow-up dentist 1-2 weeks
Necrotizing need dentist for debridement in 24-72 hours (1 day if severe)
Immunocompromised, extensive or systemic needs abx
What are your go to antibitoics for severe dental and gum infections according to Rosen’s?
What is pericoronitis? What is the classic story? Two red flags on physical exam? What is the pathophysiology? How do you manage it?
Inflammation of the gingiva and bone surrounding a tooth
When tooth erupts you get bacteria between the tooth and soft tissue, creates a flap called an operculum that is painful and swollen, worse the more you chew on it
20-30s painful wisdom tooth with overlying swollen flap of skin
If you can wiggle tooth you have alveolar bone loss (deeper than gums)
If interdenal papilla are blunted or punched out with pseudomembrane worry it is necrotizing
Rinses
If severe gets penicillin, allergic clinda
Dentist
Two things that cause gingival hyperplasia most commonly? One emergent diagnosis you want to rule out?
Plaque -> inflamamtion
Meds (immunosupressant, anti-epileptic, CCB)
Leukemia (puffy gums from infiltration - espeically if no meds and good oral hygiene)
Triad of necrotizing peridontal disease?
Papillary necrosis, gingival bleeding, pain
What is the medical word for a canker sore? How do you treat them?
Aphthous ulcer (apthous comes from the greek word for eruption, means ulcer)
small 2-3 cm superficial tender mucosal lesions with a whitish center
Usually not infected, think HIV, Bechets, crohns
Treat with hydrogen peroxide rinses
What is this? How is this different from hand foot and mouth?
One cause of pain immediately after a root canal?
Residual gas bubbles that are inadvertently sealed into a cavity. Patient feels it right after the nerve block wears off (too early for infection). Send back to dentist.
Alternative is swelling elevates tooth you feel it during chewing (will get better on its own)
What are the two spaces that get infected with maxillary infections and how do they present?
Canine - infetions of the root of the maxillary canine into the canine space
Get flattening of the ipsilateral nasal labial fold. **worry about CST it sits right behind this
Buccal - Infetion that comes from the molars. Get a big puffy cheek. Can involve maxillary sinus
What are the three spaces that get infected with mandibular infections and how do they present?
Submental - Caused by mandibular inscisors (only teeth there). Very discreet midline swelling (bound by muscles).
Sublingual - Floor of the mouth. No posterior boarder so goes back into mabmandibular space. Causes firmness on floor of mouth and elevates tongue
Submandibular - Molars. Communicates with other spaces including travelling to the other side.
Outline 4 scenarios of infections gettings worse:
Tonsilitis
UTRI
Dental infection
Iatrogenic (intubation or trauma)
I cant decide if this is relevent or not.
