Oral, Tongue, and Mouth Disorders Flashcards
What is the primary result of poor dentition?
chronic inflammation
What can the chronic inflammation due to poor dentition lead to/complicate?
diabetes heart disease failure to thrive at all ages pregnancy problems oral and gastric cancers
List three primary risk factors for oral illness?
medications
smoking/drinking/meth
peircings
In what age group can cavities be prevented?
ALL
What presenting symptoms in oral illness are especially bad?
white and brown spots
What is most effective at preventing oral illness and maintaining oral health?
topical fluoride
What two situations are dental emergencies?
knocked out permanent tooth
cellulitis
What is Oral Candidiasis?
Thrush
overgrowth of fungus Candida albicans in the mouth
fairly common, but can signal an underlying disease
What is Candida albicans?
a fungus that has a normal presence in the mouth, but whose overgrowth can cause problems
Where is Oral Candidiasis most often seen?
infants
debilitated patients with poor dental hygiene/denture care
uncontrolled diabetes
anemia
patients undergoing chemotherapy or head/neck radiation
those taking corticosteroid medications (improper inhaler use)
those taking broad-spectrum antibiotics
Why is Oral Candidiasis important to identify in adults?
Oral Candidiasis in adults is a sign of immunocompromise; if there is no reason for immunocomprimise, they need to be worked up for HIV or other causes of immunocompromise
What is the key physical exam finding of Oral Candidiasis?
white patches that can be easily rubbed off with a gloved finger or tongue depressor
What are symptoms of Oral Candidiasis?
painful, creamy-white patches overlying erythematous (angry red) mucosa
How is Oral Candidiasis diagnosed?
clinically
wet-prep mount can be done with potassium hydroxide - will reveal spores and may show non-septate mycella
How is Oral Candidiasis treated in adults?
oral flucanazole, ketoconazole, clotrimazole (small lozenge between cheek and gum), nystatin mouth rinses
What do -azoles generally signify?
antifungal medications
How is Oral Candidiasis treated in infants?
nystatin liquid applied directly to affected area; check breastfeeding mother
How are HIV patients or immunocompromised patients with Oral Candidiasis treated?
longer courses of treatment may be needed
itraconazole or voriconazole
What is Leukoplakia?
white lesion in the mouth that CANNOT be removed by rubbing the mucosal surface; often hyperkeratosis (thickening of skin) due to irritation; squamous cell carcinoma in 2% of cases!
In what groups is Leukoplakia most often found?
males over the age of 45
smokers
alcoholics
What are symptoms of Leukoplakia?
can range from flat, translucent white patch in the early stages to slightly elevated plaque with granular texture
late-stage - thickened lesion with fissuring and underlying erythema
CANNOT be removed form surface
What should you look out for if a patient has Leukoplakia?
2% of cases are cancerous, so any leukplakic area that is enlarging or has mucosal depth shoudl be incisioned and biopsied to rule out cancer. Have a specialist evaluate so that you don’t miss cancer.
How is Leukoplakia treated?
There are no approved therapies; just rule out cancer.
What is Erythroplakia?
red plaque
similar to leukoplakia, except there is a definite erythematous component
smoother in appearance
Why is it important to differentiate between Leukoplakia and Erythroplakia?
90% of Erythroplakia is either dysplasia or carcinoma - REFER IMMEDIATELY!!!
What is Oral Harry Leukoplakia?
a whitish area that shows up on the border of the tongue, but has a corrugated appearance with small “hairy” looking areas; sudden onset; not painful, but uncomfortable
In what illnesses is Oral Harry Leukoplakia commonly seen?
Oral Harry Leukoplakia is a common finding in early HIV and may be triggered by Epstein-Barr Virus
How do you differentiate Leukoplakia from Oral Harry Leukoplakia?
Oral Harry Leukoplakia localizes on the border of the tongue, has harry looking areas, CANNOT be wiped away, and have a sudden onset
How is Herry Leukoplakia treated?
It usually is not treated, but if patient is HIV positive, it would warrant a closer look at how well controlled their HIV is - may be sign of new or worsening disease.
What is Oral Lichen Planus?
relatively common (2% of population) chronic inflammatory autoimmune disease of oral mucosa; many different subtypes; wide range of presentations; may increase the risk of developing oral cancer
What are symptoms of Oral Lichen Planus?
burning
pain
discomfort
In what group does Oral Lichen Planus occur most often?
more common in middle-aged, adult women
What other tests might you order if you think a patient has Oral Lichen ?
incisional or small excisional biopsy if you are concerned about oral cancer
How is Oral Lichen Planus treated?
coticosteroids, topically and systemically
How does the skin condition Lichen Planus relate to Oral Lichen Planus?
Some patients just have Lichen Planus of the skin, some have it in both, and some have it only in the mouth.
What is the most common type of Oral Cancer?
squamous cell carcinomas
How does Oral Cancer present?
early lesions can look like leukoplakia or erythroplakia
more advanced lesions tend to look larger, may protrude, and may feel hard
usually asymmetric
ulceration (nonhealing) may be present
patient may describe lump or thickening of oral tissue
changes in voice may occur
difficulty swallowing, speaking, or moving the tongue
How is Oral Cancer diagnosed?
biopsy
early detection is key, but most oral cancer is at least locally advanced by the time it is discovered
What are risk factors for Oral Cancer?
age over 40 history of previous head or neck radiotherapy cigarette smoking heavy alcohol use HPV infection
Why is it important to be vaccinated for HPV?
HPV may be responsible for 70% of oral cancers
HPV type 16 is thought to be responsible for 60% of oral cancers in the US
How is Oral Cancer treated?
depends on stage
if less than 2 cm in size, local resection
larger tumors are generally treated with a combination of surgical resection, neck dissection, and radiation
reconstruction if required
What are Aphthous Ulcers?
canker sores, ulcerative stromatitis
very common lesions found in the buccal and labial (lip) mucosa (not on gingiva or palate); may be single or multiple
What causes Aphthous Ulcers?
unknown, but it is thought to be caused by herpesvirus 6
How do Aphthous Ulcers present?
panful, small, round ulcerations with yellow-gray fibrinoid centers surrounded by red halos
minor are less than 1 cm
major are more than 1 cm and can be very painful
How are Aphthous Ulcers treated?
topical corticosteroids (triamcinolone, fluocinonide) magic mouthwash (viscous lidocaine, mylanta, diphenhydramine) - warn not to overuse prendisone taper if severe
What is Herpetic Stomatitis?
herpetic gingivostromatitis
fairly common herpes simplex infection of the gums and oral cavity
How does Herpetic Stomatitis present?
usually mild and short-lived in adults, but can be severe in immunocompromised patients
patient usually reports having had initial burning sensation followed by the development of small vesicles and rupture
lesions usually located on the mucocutaneous junction of the lip, but can also form on the tongue, buccal mucosa, and soft palate
How is Herpetic Stomatitis treated?
oral antivirals (Acyclovir - 5X per day poor compliance, Famiclovir, Valacyclovir) should be started within 24-48 hours of outbreak to be effective
What is Necrotizing Ulcerative Gingivitis?
Trench Mouth, Vincent’s Angina
rare overgrowth of oral bacteria that causes an ulcerative infection of the gums
In what age group does Necrotizing Ulcerative Gingivitis most commonly occur?
ages 15-35
What are risk factors for developing Necrotizing Ulcerative Gingivitis?
poor oral hygeine stress poor nutrition smoking throat, mouth, and tooth infections
What are symptoms of Necrotizing Ulcerative Gingivitis?
painful, acute gingival inflammation and necrosis
possibly grey or black gums
bleeding
halitosis (bad breath)
fever
cervical lymphadenopathy (enlarged lymph nodes)
How is Necrotizing Ulcerative Gingivitis treated?
penicillan for 10 days
may need dental gingival curettage
Glossitis
inflammation of the tongue caused by anemia, fix underlying tissue
Angular Cheilitis
red, swollen patches in the corner of your mouth at the angle where your lips meet; most commonly caused by fungal infection
Glossodynia
painful tongue
most common in elderly men
no specific treatment
Dysgeusia
altered taste
