Orathon4: adventures in cramming Flashcards by Tim Agee

By definition, Pulpitis is inflammation involving the _________

Sometimes only dilation of _________

dental pulp

blood vessels

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2 causes Pulpitis?

Caries

Trauma (Dental restorative procedures!)

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Symptom of Pulpitis:

Pain

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Reversible Pulpitis: Pain from hot/cold ______ after stimulus removed

Pain is ______ in intensity (intermittent, not always present/reproducible)

Radiographic appearance:

Tx:

fades rapidly

variable

normal

Remove cause if ID or Time!

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Irreversible Pulpitis: After stimulus removed:

Varying pain, mild, intermittent to _______

3 stimuli that can produce pain:

Pain may be spontaneous and could be triggered by what?

Pain may be _______

Radiograph:

Tx:

Pain lingers

excruciating

Hot/Cold, Chewing pressure, Percussion

Lying down

continuous

widened PDL

Endo or Extraction

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Chronic Hyperplastic Pulpitis, aka…

Caused by what?

Pulp does what?

Typically very sensitive to what?

Tx:

Pulp Polyp

Carious exposure of pulp

Pulp grows into crown (soft red tissue mass)

touch

Endo or Extraction

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Pulp Necrosis: death of the pulp due to overwhelming ______ in a confined environment

Bleeding in the pulp chamber results in RBC’s spilling into _______, causing _______

Symptoms:

Often sensitive to :

Radiographs: (2 things)

inflammation

dentinal tubules, discoloration

no pain to intense pain

percussion

PDL thickening or destruction of periapical bone

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Periapical lesions are the result of what?

pulpitis (pulpal inflammation)

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What % of periapical lesions progress to pulp necrosis?

95% or greater

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A tooth with periapical pathology will be _______ when tested

non-vital

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3 results of testing a non-vital tooth with periapical pathology

no response to hot/cold

no response to electric pulp testing

percussion/mastication tenderness may still be present

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What is the earliest change in periapical pathology?

longer duration?

widened PDL at apex

symmetric apical radiolucency

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4 types of localized periapical lesions:

periapical granuloma

apical periodontal cyst

periapical abscess

periapical scar

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3 potential sequelae to localized lesions:

sinus tract

osteomyelitis

cellulitis

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Periapical Granuloma, aka…

Chronic Apical Periodontitis

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What is the most common periapical pathosis?

Periapical Granuloma

aka Chronic Apical Periodontitis

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Periapical Granuloma is the accumulation of apical inflammatory tissue in response to what?

what type of inflammation?

may be found in transition from what 2 things?

noxious products of pulp necrosis

chronic

periapical abscess/apical perio cyst

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Periapical Granuloma Clinical presentation:

Radiographic presentation:

Tx:

asymptomatic, tooth not mobile, not percussion sensitive

variable, symmetrical, well defined, punched out border, diffuse, loss of Lamina Dura, root resorption

endo (surgical/conventional) or extraction

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Periapical Granuloma will see the loss of what in the root tip area of the radiolucency

Lamina Dura

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Apical Periodontal Cyst aka…. (2 things)

Periapical Cyst

Radicular Cyst

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Apical Periodontal cyst is an epithelial proliferation/cyst formation resulting from what?

inflammatory stimulation of epithelial remnants of Hertwig’s Epithelial Root Sheath

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How does Apical Periodontal Cyst present clinically? (4 things)

asymptomatic

not mobile

adjacent tooth displacement can occur

does not enlarge alveolar bone

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Apical Periodontal Cyst radiographic presentation:

lucent lesion, variable, punched out border, lamina dura loss, root resorption

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3 patterns of Apical Perio Cyst radiographic presentation:

Classic: root tip lucency

Lateral: side of root (lateral root canal)

Residual: remains following extraction

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Tx of Apical Perio Cyst:

surgical/conventional endo or Extraction

Acute inflammation due to pulpal necrosis with spread of noxious products into the periapical region

Periapical Abscess *can also be periapical granuloma

Periapical Abscess can result from what 2 apical conditions?

periapical granuloma apical periodontal cyst

Symptomatic Periapical Abscess clinical presentation: Asymptomatic:

percussion/mastication/palpation pain, variable intensity, increasing pain w/ time, Swelling, Active infection painless, swelling in vestibule/periapically may accompany

Periabical abscess radiographic findings: Tx:

none obvious to radiolucency, ill-defined, PDL thickening possible conventional endo/extraction/analgesics for pain

Periapical Scar is due to healing ________, _______, or _______ typically occurs when there has been destruction of ______ on lingual and buccal to tooth most commonly follow _______

periapical granuloma, apical perio cyst, periapical abscess cortical bone surgical endo therapy

3 major types of Sequelae to Periapical Pathology:

Sinus Osteomyelitis Cellulitis

Sinus sequelae to Periapical Pathology results from what?

Pus dissecting through bone *path of least resistance

Depending on the tooth involved and the path of least resistance, Sinus Tract Sequelae from periapical pathology can result in what 2 areas?

Oral cavity Skin surface

Sinus trace sequelae from periapical pathology resulting in pus to Oral Cavity, aka... What are the 2 types?

gum boil hole w/ redness, enlarged nodular mass

Enlarged Nodular Mass (periapical pathology causing sinus tract sequelae) can be what colors? sessile or polyploid most are found on what aspect? Why? Tendency to _____ perforation

yellow/white/red/purple true buccal, thinner cortical bone lingual perforation:

If a Nodular Mass (periapical pathology causing oral cavity sinus tract sequelae) has a Lingual Perforation, what 3 teeth are usually involved?

Mx LI's Mx molars - palatal roots Mn 2nd and 3rd molars

If periapical sequelae reaches the skin it typically involves... multi-colored, and what teeth are involved?

enlarged nodular mass mandibular teeth

Periapical inflammation spreading into adjacent bone w/o drainage

Osteomyelitis

Inflammation unable to etsablish drainage that spreads through soft tissues:

Cellulitis

Cellulitis usually spreads through ______ What are the 2 types associated w/ Dental Infections?

layers (planes) Ludwig's angina, Cavernoous sinus thrombosis

Ludwig's Angina typically results from an abscess of what tooth? involved rapid swelling of what 3 areas? Which causes elevation of the tongue?

Mandibular molar sublingual, submandibular, submental sublingual

Cavernous sinus thrombosis typically results in an abscess of what teeth (2)? What is the most common source of infection? swelling involves what tissues?

Mx anterior, Premolar Canine periorbital (eyelids, conjunctiva), may also involve lateral nose/forehead

Possible sequelae to Cavernous Sinus Thrombosis:

protrusion/fixation of eye pupil dialtion lacrimation meningitis brain abscess/death

Decrease in hemoglobin resulting in inability to oxygenate tissue

Anemia

3 types of Anemia:

Iron deficiency: most common Pernicious: loss of IF, can't absorb B12 Sickle Cell: hemolytic

What is the most common type of Anemia? Associated syndrome? Oral consequence of syndrome?

Iron deficiency Plummer-Vinson Syndrome increases oral/esophageal carcinoma

Oral findings of Sickle Cell:

Pain and burning (glossodynia/glossopyrosis) glossitis, angular chelitis, apthous ulcers candidiosis bone density loss

Uncontrolled overproduction of RBC's, platelets, and WBC's. Blood becomes viscous

Polycythemia vera

What are the oral findings of Polycythemia Vera?

Erythematous mucosa

2 General types of WBC disorders:

Leukopenia (decreased WBC) Leukocytosis (increase WBC)

2 types of Leukopenia (decrease WBC):

Agranulocytosis (neutropenia) - decreased neutrophils Lymphopenia - decrease in lymphocytes (immunosuppression)

Agranulocytosis (neutropenia) oral presentation: Lymphopenia sequelae:

ragged non-healing oral ulceration viral/fungal infections

Leukocytosis (increased WBC) can be due to what 2 conditions?

Physiologic (infection) Leukemia (WBC malignancy)

Primary oral consequence of Leukemia: secondary:

diffuse gingival hyperplasia, radiolucency infection and bleeding

Poverty of thrombocytes

Thrombocytopenia *no platelets

Thrombocytopenia can be primary (immune) or secondary to another condition like ________

leukemia (or drug use)

What are 3 oral manifestations of Thrombocytopenia?

petechiae (red spots) ecchymosis purpura around necks of teeth

Hemophilia is an ____ linked deficiency of clotting factor ______ *causes deep bleeding, joints, internal organs

x linked VIII

Idiopathic facial paralysis: What nerve affected? this is a ______ neuropathy describe onset: Most have _____ recovery, but there should be a neurosurgical consultation

Bells Palsy VII postviral abrupt, unilateral, middle age complete

3 attributes of Melkersson-Rosenthal Syndrome:

cheilitis granulomatosis fissured tongue facial paralysis (this is NOT Bell's palsy)

Tic Douloureux:

Trigeminal neuralgia *V

Trigeminal neuralgia affects what age group most? If under 30 suspect what?

45-55 MS (demyelinating plaques)

Trigeminal neuralgia is what kind of pain? follows _____ zone manipulation lasts seconds to a minute and is _______ affects any division of V

acute, excruciating, abrupt trigger unilateral True

Trigeminal neuralgia may be caused by anatomic abnormalities in what?

Ganglion

Tx Trigeminal neuralgia: ____% get relief from ______ (drug) _______ radiofrequency trigeminal gangliolysis _______ knife radiation neurosurgical ________

75%, Tegretol (anticonvulsants) percutaneous Gamma decompression

Endocrine system produces hormones that are secreted directly where? meaning there is no...

blood stream duct system

6 components of the Endocrine System:

Pituitary Thyroid Parathyroid Adrenal (cortex and medulla) Pancreas (langerhans) Gonads

Generally there area 2 diseases for every Endocrine Organ

True *overproduction and underproduction

Hyperfunction of an Endocrine Organ can be caused by what 3 things?

Hyperplasia Functional neoplasia Loss of negative feedback signal

Hypofunction of Endocrine Organ is usually caused by what 2 things?

Destruction Loss of positive signal

Signs/symptoms of Endocrine diseases tend to be _________

multifocal *not local

You are unlikely to diagnose an Endocrine disorder by looking in the mouth

True *oral manifestations uncommon

The pituitary gland is in the Sella Turcica below what?

hypothalamus

The Anterior Lobe of the Pituitary, aka... derived from what?

adenohypophysis Rathke's Pouch (oral mucosa)

6 hormones secreted by the Anterior Pituitary 1 by the Pars Intermedia: 2 by the Posterior Lobe:

GH, ACTH, TSH, FSH, LH, LTH MSH ADH, Oxytocin

What is unique about the Posterior Lobe of the Pituitary?

Neurohypophysis *extension of the CNS

GH, 2 Hyperfunction: 1 Hypofunction:

Giantism, Acromegaly Dwarfism (normal proportions)

Gigantism onset: _____ pts have ______ syndrome 2 oral manifestations:

pre-pubertal 1/5, McCune-Albright macrodontia (!), Mn enlargement/prognathism

Giantism onset Acromegaly onset

pre-pubertal post pubertal

4 Oral manifestations of Acromegaly:

Skull/jaw enlargement Mn prognathism Diastemas Macroglossia

Giantism, big Acromegaly, big *orally

teeth tongue

Acromegaly has Mn prognathism, often with what?

Anterior Open Bite

4 Oral manifestations of Dwarfism (GH hypofunction):

delayed eruption, deciduous retention microdontia no 3rd molars crowding

Hyperfunction ADH: Hypofunction ADH:

lots of ADH, no oral manifestations Diabetes insipidus, no oral manifestations

Thyroid gland located just below what? Primarily regulates what? 2 hormones produced?

laryngeal prominence cellular metabolism thyroxine, Calcitonin

Thyroid Hyperfunction (2): Thyroid Hypofunction (2):

Grave's, Multinodular Goiter Cretinism (congenital), Myxedema (acquired)

3 Oral manifestations of Hyperthyroidism: potential complication dental Tx:

U shaped mass in neck, burning tongue, tremor of tongue Thyroid Storm

3 Oral manifestations of Cretinism (congenital hypothyroidism)

Large protruding tongue Delayed development/eruption Caries/Perio secondary to Retardation

2 Oral manifestations Myxedema (acquired hypothyroidism)

Enlarged tongue Lingual thyroid nodule

Calcitonin is secreted by what?

Parathyroid

How many Parathyroid glands are there? Where located? regulates what? What hormone?

4-6 anterior neck (often in Thyroid gland) Calcium PTH

What are 3 Oral Manifestations of Hyperparathyroidism?

Jaw radiolucencies Loss of trabecular pattern "Ground Glass" Loss of Lamina Dura

What are 3 Oral Manifestations of Hypoparathyroidism?

Partial anodontia Malfomed/hypoplastic teeth Increased candidiasis

Adrenal Cortex responsible for what? Hormones produced:

Electrolyte/fluid balance, stress management, inflammatory response Mineralcorticoids (Aldosterone) and Glucocorticoids (Cortisol)

Where are Mineralcorticoids and Glucocorticoids produced? Example of each:

Adrenal Cortex Aldosterone (mineralcorticoid) Cortisol (glucocorticoid)

The Adrenal Medulla is responsible for the regulation of ________ and _______ Produces what 2 hormones?

cardiac output, blood pressure epinephrine, norepinephrine

Hyperfunction of the Adrenal Cortical hormones produces what Syndrome? 2 Oral manifestations of said syndrome:

Cushing's Moon face, decreased tongue/masticatory muscle mobility

Hypofunction of Adrenal Cortical hormones produces what 2 diseases?

Waterhouse-Fridrichsen's (acute) Addison's (chronic)

Describe Waterhouse-Friderichsen's Disease onset: oral manifestations: *remember, this is Acute Adrenocortical Insufficiency

sudden, death w/in 3 days none

Addison's disease major potential dental complication: 2 Oral manifestations:

Addisonian crisis Bronzing, macular pigment oral mucosa

Adrenal medulla hyperfunction: hypofunction:

100% pheochromocytoma none ever

Endocrine Pancreas scattered w/in the parenchyma of the exocrine pancreas:

Islets of Langerhans

Islets of Langerhans 4 cell types what do each secrete?

Alpha Cells - glucagon Beta Cells - Insulin Delta Cells - Somatostatin PP cells - pancreatic polypeptide

Somatostatin is produced by _____ cells and counteracts ________

Delta GH

Hyperfunction insulin: Hypofunction glucagon:

hypoglycemia (no oral manifestations) Diabetes mellitus

Inadequate insulin can lead to what complication of dental Tx? 3 Oral manifestations:

Diabetic coma delayed healing, infection, perio

Puberty, Pregnancy, Menopause

Gonadal endocrine system

2 sites of Gonadal Endocrine in Males: 2 sites in Females:

Testes, Adrenal cortex (weak) Ovaries, Adrenal cortex (small quantities)

Hyperfunction of Gonadal Endocrine: Hypofunction:

gingival hyperplasia oral pigmentation

Hypofunction of Gonadal Endocrine can lead to oral pigmentations due to concomitant secretion of _______ from ______

MSH pituitary gland

The oral lesions seen in AIDS pts are similar to other immunosuppressive states/autoimmune disorders such as what 3 medically induces states?

Chemo Anti-rejection meds Marrow transplant pts

The more complete the immune deficiency the more florid the manifestations and accelerated the clinical course, less effective the Tx

True

Oral sequelae is seen in ___% of AIDS/pre-AIDS pts

70%

Oral sequelae in AIDS pts include viral/bacterial/funga infections and ______

neoplastic disease

The most important Tx planning considerations in pre-AIDS pts are ________ and ________ *also recognition/management oral manifestations

time interval for Tx completion preparation for immunodeficient state

3 herpes infections seen in HIV 2 HPV in HIV

simplex, varicella zoster, EBV Papilloma, condyloma acuminata

Herpes simplex in HIV are recurrent labialis and intraoral Lesions begin as... lesions increase in number, size, duration Tx:

True vescicles True Antiviral therapy, fluids, analgesics

Varicella-zoster begin as _____ progress to ______ _____ lesions often accompany oral lesions can manifest as more _____

vescicles ulcerations skin florid (red)

Tx Varicella-zoster *remember, this relates to HIV

Antiviral Topical ointment for skin lesions

What virus is an etiologic factor in Oral Hairy Leukoplakia?

EBV

Papilloma clinical presentation: Tx:

cauliflower, pedunculated, normal to pink, antiviral, surgical excision

Condyloma acuminata clinical presentation: Tx:

caulliflower, papillary, NOT pedunculated (wide base), white antiviral of LITTLE VALUE, Surgical excision

What oral indicator is a predictor for the progression of full blown AIDS? positive association with... 2 possible co-factors:

Oral hairy leukoplakia EBV (HHV 4) papilloma virus, candidiasis mediated

Clinical presentation Oral hairy leukoplakia:

lateral border of tongue bilateral asymptomatic (pts unaware)

A white, non-wipeable plaque in a vertical/linear pattern with a shaggy surface (although sometimes smooth) that may spread to other areas

oral Hairy Leukoplakia

Is Oral Hairy Leukoplakia treated in association with HIV? Lesions may regress w/ what?

maybe? anti-AIDS regimen

4 HIV associated perio diseases:

Linear Gingival Erythema NUG NUP Necrotising Stomatitis

3 bacteria that rarely cause oral manifestations in AIDS pts:

Mycobacterium avium intercellulare Klebsiella pneumonia Enterobacter cloacae

3 bacterial species increased in HIV perio pts

Eikenella Wolinella Bacteroides

HIV associated perio disease is Candidiasis mediated

False but maybe???

HIV associated perio resembles what? does it respond to conventional perio therapy?

ANUG no - even w/ good plaque control

Tx HIV perio:

difficult *plaque control, debridement, SRP, CHX

Previously called HIV associated gingivitis: A soft tissue necrosis that is _______ progression:

Linear Gingival Erythema very painful to more severe in short period

NUG in HIV, often a transitional between _______ and more severe forms of involvement Usually affects where?

Linear Gingival Erythema focal, interdental papilla, bone destruction

NUP in HIV, severe loss of what? Minimal _____ Interproximal ______ Loss of _____ and severe _____

PDL attachment pocket formation cratering bone, pain

HIV Necrotizing Ulcerative Stomatitis is _____ with spread to _______

NUP soft tissue/bone OUTSIDE alveolar ridge areas *most severe form of disease

3 fungal infections associated with HIV:

Candidiasis Histoplasmosis Cryptococcosis

What are the 4 Clinical Presentations of Candidiasis?

Pseudomembranous Hyperkeratotic (hyperplastic) Erythmatous (atrophic) Angular chelitis

Candidiasis is due to immune deficiency and is seen in ___% of AIDS/pre-AIDS pts symptoms are variable Tx:

75% True Anti-fungals (longer/more potent)

Clinical presentation Pseudomembranous candidiasis:

Creamy white non-wipeable milk curd erythematous background

4 commonly affected areas of Pseudomembranous candidiasis (HIV related):

Palate Buccal/Labial mucosa Dorsum of Tongue

Clinical presentation Hyperkeratotic (hyperplastic) candidiasis: 3 things *what area is commonly affected?

White plaque (irregular) non-wipe normal colored mucosa in background *Buccal mucosa

Erythematous (atrophic) candidiasis clinical presentation: color: area: texture: 3 commonly affected areas:

red to pink diffuse involvement velvety Palate, Buccal Mucosa, Dorsum of Tongue

Angular chelitis Clinical presentation: May spread to skin/lip ______ areas _______ Background cracking, crusting, and _______ on opening movements often accompanied by other candidiasis

vermillion Diffuse Erythematous bleeding True

2 most common Fungal oral infections (w/ HIV)

Histoplasmosis Cryptococcosis

Oral fungal lesions in HIV usually accompany widespread involvement

True

3 neoplasms associated with HIV

Kaposi's sarcoma Non-Hodgkin's lymphoma Squamous cell carcinoma

2nd most common malignancy of AIDS when AIDS pt contracts, what is the course?

Non-Hodgkin's lymphoma aggressive, survival a few months

Clinical presentation Non-Hodgkin's Lymphoma (AIDS): tissue: most commonly affected site (though can occur anywhere): palpation: pain: Ulceration due to _____ often seen May be the 1st presentation of ______ disease

soft tissue enlargement Palate/Gingiva Firm Painless Trauma Systemic

Squamous Cell Carcinoma is increased in HIV pts

False *questionable

Kaposi's sarcoma may or may not be a real neoplasm and is diffuse, uncontrolled _______ in an immune deficient patient

angiogenesis

Kaposi's sarcoma associated with what virus? Is the initial manifestation in ___% of AIDS pts

HHV VIII 30%

Kaposi's sarcoma is more common in what 2 demographics?

whites, homos

What comes first in Kaposi's sarcoma, oral or skin lesions? % w/ only oral? % KS w/ oral lesions? % w/ skin lesions that have oral lesions

Oral often 1st 10% 54% 50%

HIV KS often shows _____ clinical course Often _____ to therapy Less commonly seed in what demographic?

aggressive resistant pediatric

Clinical prez, KS: _____ colored lesions _____ to slightly raised Nodular lesions May show _____ in Nodular phase Solitary/multiple/diffuse

red to purple macular (distinct spots) ulceration True

HIV KS most has a preference for what tissue? What 2 areas specifically? *remember, can be anywhere

keratinized mucosa Hard palate, Gingiva

Tx KS from HIV

Excision for isolated lesions Laser larger areas