Oral medicine and OMS: Kang, DMD Flashcards
What is gingivitis?
- inflammation of tissues surrounding the teeth (gums)
- can be necrotizing ulcerative gingivitis, or medication-influenced gingivitis
- tx: oral hygiene, scaling/root planing, periodontal surgery
What is periodontal disease?
- inflammation surrounding teeth causing loss of bone and PDL
- progressive loss of attachment leads to significant loss of alveolar bone and attachment
- periodontitis associated with systemic disease
- tx: oral hygiene, scaling/root planing, periodontal surgery
What is alveolar osteitis?
this is inflammation of the alveolar bone, aka “Dry socket”:
After tooth extraction, a blood clot forms and will eventually be replaced by granulation tissue and bone. When the blood clot fails to form or is lost, it’s called “dry socket” - occurs following 1-3% of all extractions, 25% of wisdom teeth extractions
Sx: extreme pain and foul odor
Tx: pain meds, medicated dressings, remove debris, flush socket and oral hygiene, abx not necessary
Fungal infections of the mouth; Pseudomembrane and Erythematous candidiasis
Candidiasis
- opportunistic infection of candida in the mouth
Pseudomembrane candidiasis (thrush):
- affected area becomes tender with red and white areas; white areas are debris mixed with candida - can scrape away
- tx: remove underlying factor, nystatin oral, clotrimazole lozenge, Fluc/Keto/Itraconazole
Erythematous candidiasis (more common than thrush but often overlooked)
- no white flecks, rather varying degrees of erythema/petechiae
- commonly from dental trauma - debate re: true infection or host tissue response
- subtypes: acute atrophic candidiasis follows course of Abx, denture stomatitis from wearing dentures
- tx: oral hygiene, keep dentures out at night
What dental procedures require prophylaxis for bacterial endocarditis, and which do not?
Do: for someone with prosthetic cardiac valves, previous endocarditis, congenital HD, or heart transplant with valvulopathy undergoing:
- Extractions
- Periodontal procedures
- Dental implant placement
Don’t:
- Fillings
- Local anesthetic injection
- Removal of primary teeth
What is torus mandibularis and torus palatinus?
Torus mandibularis: common exostosis that occurs on the posterior aspect of lingual aspect of mandible; cause maybe environmental (masticatory stress) vs. genetics. Bilateral 90%; present in 7-10% of the population
Torus palatinus: common exostosis that occurs in the palate; not present until late teens/adulthood; no malignant potential. Present in 9-40% of population.
What is hairy tongue and what is the treatment?
The accumulation of keratin on filiform papillae on the dorsal tongue (spares ant. and lat. borders).
Cause is likely from poor oral hygiene and smoking; appears black from bacteria and staining from smoking/debris.
Found in .5% of adults and is benign.
Treatment:
Eliminate predisposing factors such as smoking; improve oral hygiene; periodic scraping with a tongue scraper or toothbrush
What is hairy leukoplakia?
- an opportunistic infection most commonly in HIV patients that presents with a “hairy” or corrugated surface on the lateral border of the tongue; short white strands that project from the surface epithelium
- associated with EBV
Tx: nothing specific; can give anti-retrovirals
What is oral erythema migrans “geographic tongue”?
- this subtype of erythema migrans involves only the dorsal and lateral aspects of the tongue mucosa
- presents as areas of erythema surrounded by elevated yellow scalloped borders
- a very common entity of unknown etiology and pathogenesis
- affects 1-3% of the population
- Tx: none; reassurance
What is an aphthous ulcer?
- destruction of the oral mucosa; appears to be a T cell mediated immunologic reaction
- common, present in 20% of population
- multiple causes which may include allergies, hormones, trauma, stress, smoking
- Tx: usually not necessary, can use OTC anesthetics or topical steroids
What is leukoplakia?
- Leuko=white / plakia=patch
- defined by the WHO as a “white patch or plaque that cannot be characterized clinically or pathologically as any other disease” – a clinical term and diagnosis of exclusion
- tx: biopsy for definitive diagnosis; excision for any dysplasia
Ondontogenic cysts
- these are odontogenic-derived epithelial cysts; subclassified into developmental and inflammatory
- Inflammatory cysts: Periapical cyst; Residual cyst
- Developmental cysts: (DECLOG) Dentigerous cysts; Eruption cyst; Calcifying odontogenic cyst; Lateral periodontal cyst; Odontogenic keratocyst; Glandular odontogenic cyst
What is a dentigerous cyst?
- a cyst that originates by the separation of the follicle from around the crown of an unerupted tooth
- not painful unless secondarily infected
- 2nd most common cyst; usually in the posterior mandible or maxilla; associated with wisdom teeth; can grow to a large size and cause bony expansion/facial fullness
- tx: enucleation
Odontogenic keratocyst (OKC)
- rare, benign but locally aggressive and recurrent odontogenic cyst; resemble both cyst and tumor
- histo: lined by stratified squamous epithelium with a parakeratinized and often corrugated surface; basal cells are hyperchromatic, cuboid-columnar, and have palisaded nuclei; usually no inflammation
- peaks in teens/20s but can occur at any age; in kids associated with basal cell nevus syndrome
- 2x in mandible > maxilla; small/unilocular to large/multilocular
- can cause bony expansion and tooth mobility but most are asymptomatic
- tx: marsupialization, enucleation and curettage, or resection
Ameloblastoma
- tumor of odontogenic epithelium
Bisphosphonate related necrosis of the jaw (BRNOJ)
- bisphosphonates cause decreased bone turnover (inhibited resorption) and antiangiogenesis; basically can’t address impending infections
- stages of infection/disease:
1. exposed bone; no bone or soft tissue inflammation
2. painful areas of exposed bone; with soft tissue or bone inflammation
3. most advanced stage, +/- fracture; extensive exposed bone and soft tissue inflammation - Dx:
1. Exposed bone in maxillofacial region, for >8 weeks
2. Current/previous bisphosphonate therapy
3. No hx of radiation therapy of the jaws
What is verrucous carcinoma?
- a low grade variant of oral squamous cell carcinoma; slow growth but locally aggressive (mets are rare)
- Lesion appears diffuse, well demarcated, painless, thick plaque with papillary projections
- associated with HPV 6, 11, 16, 18, and chewing tobacco or snuff (where tobacco is habitually placed), generally men >60yo
- Tx: surgical excision with adequate margins
Squamous cell carcinoma of the mouth
- tongue and floor of mouth are the most common sites of origin for primary SCC in the oral cavity
- clinical features are variable–can be superficial or deep, ulcerative, exophytic or endophytic
- ulcerative lesions = irregular borders, induration, and can bleed
- biopsy with a punch or wedge excision is used to confirm the diagnosis
- if the lesion is suspicious and the biopsy does not show malignancy, then the biopsy should be repeated
- tx: staging, imaging, excision, radiation/chemo, FU
SCC of the lip
- SCC is more common on lower lip than upper (upper lip cancer is usually BCC); accounts for 25-30% of oral SCC
- 2 General Presentations:
1. slow growing exophytic mass (most common) - behaves like cutaneous SCC associated with UV light
2. eroding destructive invasive ulceration (less common); more related to pipe/cigarette smoking
What is Ludwig’s angina?
- an aggressive and rapidly spreading cellulitis that involves the bilateral sublingual, submandibular, and submental spaces
- presents as fever, swelling of the mouth/face/neck, unable to tolerate secretions
- associated with recent dental work or caries
