Orathon4: adventures in cramming Flashcards
By definition, Pulpitis is inflammation involving the _________
Sometimes only dilation of _________
dental pulp
blood vessels
2 causes Pulpitis?
Caries
Trauma (Dental restorative procedures!)
Symptom of Pulpitis:
Pain
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!
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
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
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
Periapical lesions are the result of what?
pulpitis (pulpal inflammation)
What % of periapical lesions progress to pulp necrosis?
95% or greater
A tooth with periapical pathology will be _______ when tested
non-vital
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
What is the earliest change in periapical pathology?
longer duration?
widened PDL at apex
symmetric apical radiolucency
4 types of localized periapical lesions:
periapical granuloma
apical periodontal cyst
periapical abscess
periapical scar
3 potential sequelae to localized lesions:
sinus tract
osteomyelitis
cellulitis
Periapical Granuloma, aka…
Chronic Apical Periodontitis
What is the most common periapical pathosis?
Periapical Granuloma
aka Chronic Apical Periodontitis
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
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
Periapical Granuloma will see the loss of what in the root tip area of the radiolucency
Lamina Dura
Apical Periodontal Cyst aka…. (2 things)
Periapical Cyst
Radicular Cyst
Apical Periodontal cyst is an epithelial proliferation/cyst formation resulting from what?
inflammatory stimulation of epithelial remnants of Hertwig’s Epithelial Root Sheath
How does Apical Periodontal Cyst present clinically? (4 things)
asymptomatic
not mobile
adjacent tooth displacement can occur
does not enlarge alveolar bone
Apical Periodontal Cyst radiographic presentation:
lucent lesion, variable, punched out border, lamina dura loss, root resorption
3 patterns of Apical Perio Cyst radiographic presentation:
Classic: root tip lucency
Lateral: side of root (lateral root canal)
Residual: remains following extraction
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
