Oropharyngeal Problems Flashcards
Infection of the oropharynx and tonsils
Strep Pharyngitis
sore throat, painful swallowing, fever (greater than 101.3), chills, HA, n/v, abd pain.
Bacterial (Strep) Pharyngitis
sudden onset sore throat, fever, malaise, COUGH, RHINORRHEA, HA, myalgia, fatigue.
Viral Pharyngitis
(late winter/early spring) marked erythema of throat and tonsils
Patchy, discrete, white or yellowish exudate
Pharyngeal petechiae
Tender anterior cervical adenopathy
Pressure on tonsils produce purulent drainage
Edematous uvula
NO nasal sx
Might see “strawberry tongue”
Bacterial Pharyngitis
Strep Pharyngitis
Diagnostics
•Rapid antigen detection test (RADT)
•“Send off” throat culture
•Centor criteria
- tonsillar exudate, tender or swollen anterior cervical lymph nodes, Fever, absence of cough
Centor criteria
tonsillar exudate, tender or swollen anterior cervical lymph nodes, Fever, absence of cough
Strep Pharyngitis
Treatment:
1st line Antibiotic …
If allergic to PCN?
Bacterial: PCN or amoxicillin if GAS. If non-GAS symptomatic tx.
If PCN allergy: cephalexin
Strep Pharyngitis
Education
- After 24 hours on antibiotic and afebrile, not considered contagious anymore and can return to work/school
- Buy a new toothbrush
- Clean orthodontic appliances (retainers)
what makes up early childhood caries?
Flora, the teeth, substrate (substance that bacteria eats to grow and multiply)
• Infected conjunctiva, watery discharge
(not purulent)
• Inflamed nasal turbinates with boggy
mucosa
• Pharynx may or may not be injected, can have a cobblestone appearance
• Generally no lymphadenopathy; lungs clear
allergies/PND
Patient presentation
• Complaints of irritated throat
• Hoarseness
• Clearing throat frequently
• Burning sensation in throat (also may feel in stomach or esophagus “heartburn”)
• Dry cough
• Worse after eating, especially a large meal, or lying down
GERD
Patient presentation • Complaints of long lasting sore throat • Difficulty swallowing; “lump” in the throat • Earaches • Hoarseness • Lymphadenopathy • Possibly painless lump on side of throat • Ulcerations/sores that do not heal
oral cancers
common causes of oral cancers
Squamous cell and HPV16
Physical examination for oral cancers
• Depends upon the type of cancer and the progression; early oral cancer can be
asymptomatic and difficult to notice
• Look for ulcerated lesions that do not heal
• Can be indurated as well
• Discoloration of the oral mucosa
• Leukoplakia
Inflammation of the vocal cords, can be acute or chronic
Causes
•Viral infection, GERD, vocal cord trauma, malignancy, bacterial infections (syphilis, tuberculosis)
Laryngitis
Patient presentation
•Complaints of hoarseness
•Possible cough
•Possible sore throat
Physical exam
•Noticeable loss of voice/hoarseness
•Erythematous post pharynx usually
•Overall, the physical exam depends upon the cause
Laryngitis
how to dx Laryngitis
- Mostly diagnosed by symptoms and presentation
- Can perform throat culture if bacterial infection is suspected or to rule out bacterial causes
- Can view vocal cords with laryngoscopy (usually performed by ENT)
Inflammation of one or both of the parotid glands
What causes it?
•Viral infections (usually paramyxovirus/mumps, can be HIV)
•Bacterial infections (staph, tuberculosis)
•Salivary stones (sialoliths)
•Dry mouth/possible side effect of medication
•Fungal infections
•Malignancies
Parotitis
Patient presentation •Pain and swelling on affected side (or bilaterally if both sides affected: mumps is usually bilateral) •Difficulty/painful chewing •May complain of fever •May complain of pain into the ear
Parotitis
How to dx parotitis
- Can do CBC, titers to determine cause
- Culture any pus noted
- May use ultrasound to identify salivary stones or inflammation
- CT for suspected malignancy Treatment (dependent upon cause)
how to tx parotitis if bacterial infection
If bacterial infection, treat appropriately (may need hospitalization/IV antibiotics and fluids); outpatient can use amox/clav, dicloxacillin, clindamycin, and metronidazole
how to tx parotitis if viral infection
If virus (most likely mumps) suspected, treat symptomatically and monitor
Inflammation of the epiglottis; can spread to nearby structures called “supraglottitis”
•Can cause laryngospasms and death
Epiglottitis
Primary cause of epiglottitis in kids?
Haemophilus influenzae
Primary causes of epiglottitis in adults?
Streptococcus pneumoniae and Streptococcus pyogenes
Can also be caused by traumatic injury or herpes virus
Patient presentation
•Presentation can differ in adults and children
•Children may present with difficulty breathing, stridor, drooling, look like they are in distress
•Adults may complain of a progressive, severe sore throat, dysphagia, and vocal changes
•Many adults do not have stridor but might complain of difficulty breathing; however, not common like in children
Epiglottitis
physical exam if epiglottitis suspected?
do not examine the patient’s throat with a tongue depressor!
What to do with epiglottitis?
Refer all cases of suspected epiglottitis to the ER for immediate treatment
inflammation and pain anywhere within the
oral cavity
Causes • Medications • Infectious process • Immunosuppression • Side effect of head and neck radiation • Trauma • Tobacco exposure • Dehydration • Alcohol abuse • Poor dentition and hygiene • Dental prosthetics • Neoplasms and hematologic cancers • Allergic reactions
Stomatitis
Stomatitis Treatment
- Frequent assessment
- Mouth hygiene and routine dental visits
- Remove causative agent if possible
- Antibiotics, antifungals, antivirals
Symptom relief for Stomatitis
• Coating agents such as bismuth salicylate, sucralfate, or other
antacids
• Water-soluble lubricants for mouth and lips
• Topical analgesics, such as benzydamine
• Topical anesthetics
• Oral or parenteral analgesics
• “Magic mouthwash” consists of various combinations of
diphenhydramine, magnesia-alumina, Kaolin pectin, and/or viscous
lidocaine
inflammation of the tongue
- causes : systemic, local, tongue
Glossitis
- Difficulty with mastication
- Dysphasia
- Dysphagia
- Smooth tongue surface
- Painful tongue
- Tongue color changes
- Tongue swelling
- Missing papillae
Glossitis
Glossitis tx
- Reduce inflammation
- Oral hygiene
- Antibiotics, antifungal, and antiviral if appropriate
- Treat and remove underlined cause
- Encourage proper diet
- Avoid irritants
Appears on the sides of the mouth “angular”- inflammation of one or both corners of the mouth (unilateral or bilateral)
Painful
Itchy
Red- can be confused with impetigo
Angular cheilitis
Risk factors and management of Angular cheilitis
Risk Factors:
Allergies- tooth paste, makeup, food, Infection, Fungus/ S.Aureus and it gets inside cracks
Treat the underlying cause
Barrier cream- vaseline for protective barrier
Vitamin deficiencies - check their diet, vegans at high risk
“tongue tie” caused by a short lingual frenulum- hinders tongue movement
Difficulty breastfeeding/latching (clicking sound), can affect speech later in life
Ankyloglossia
painful, shallow ulcers of oral mucosa
Risk Factors: UC, Crohn’s, gluten sensitivity, vitamin deficiencies (B, iron, zinc), trauma, hormones
Aphthous ulcers- Kanker sore
Differentials and Mgmt of Aphthous ulcers- Kanker sore
Differentials: oral CA, HSV, autoimmune disorder (DM, Crohn’s, UC)
Management: self-limited (7-14 days)
From mouth washes after getting wisdom teeth out; build up of dead skin cells where taste buds are
- black, hairy
Resolves after 1-2 weeks on its own
Black hairy tongue (mild/ temporary)
Risk Factors:
Trauma in children
Clinical Manifestations:
Bleeding in nose/ears, dizzy, h/a-ER
Broken tooth/teeth
grinding the teeth or clench teeth
Bruxism
Risk Factors: Smoking
Clinical Manifestations:
Hyperpigmentation: red and white dental lesions
Common oral lesions
- Melanoma (oral CA) usually squamous cell carcinoma
A localized collection of pus surrounding the tooth. Strep. Anginosus
Dental Abscess
difficulty moving jaw
Trismus
how to manage and tx dental abscess?
Management:
PCN, allergies-erythromycin
Root canal
I & D
Treatment
Abx: PCN or Clindamycin- 1st line, macrolides
Resistance- Augmentin
Dental Caries risk factors for adults and kids?
Adults: smokers, diabetes, cancer,
Children/ adults: developmental delay, hypertension, autoimmune, HIV, sinus infection, HPV, frequent snacking,
Children: juice at bedtime, sleeping w bottle
A chemical process that leads to irreversible acid demineralization of tooth structure
Can be intrinsic: from stomach acid/ vomiting GERD
Can be extrinsic: acidic drinks, meth, citrus foods, medications
Dental Erosion
Risk Factors: dry mouth, bulimia, GERD, asthma, medications
Clinical Manifestations: complaints of hypersensitivity
PE: smooth cupped out teeth on chewing surfaces
Dental Erosion
space between two neighboring teeth
Diastema
EMERGENCY= Inflammation of the epiglottis; can spread to nearby structures- supraglottis
Can cause laryngospasms and death
Pathogen: H. Influ b (Hib vaccination)
Adults: Strep P. and strep pyogenes
Epiglottitis (cover trachea when we swallow)
fibrous enlargement of gingival tissue - ulcerations
Risk Factors: phenytoin, cyclosporine, nifedipine, hormones, inflammation, leukemia, idiopathic
tx with Oral hygiene, chlorhexidine
Gingival hyperplasia
Clinical Manifestations: Swelling Inflamed lymph nodes Not bilateral Pain, erythema Tooth partially out of socket Usually radiates on nerve upward or downward
dental abscess
Trismus
difficulty moving jaw
discomfort especially when eating hot/ spicy food
PE: benign asymptomatic yellowish-white circular lesion with atrophic red centers appearing on anterior two thirds of the dorsum of the tongue
migrating glossitis
viral HSV 1 in children 6 mo - 5 yo
tingling, pain, and burning
PE:vesicles with erythematous base
Herpes stomatitis
how to manage / tx Herpes stomatitis?
heals in 7-14 days, remove from daycare during drooling, clean teeth with soft toothbrush, oral acyclovir can reduce symptoms if initiate within 3 days, topical antivirals ARE NOT effective
salivary gland lesion caused by a blockage of a salivary gland duct; usually caused by trauma or lip-biting
fluid filled vesicle most often on the lower lip
refer to oral sx for excision
Mucocele
partially erupted lower wisdom tooth with a tissue flap covering the crown→ food or foreign body gets under flap, causing an infection
Pericoronitis
cyst filled with mucin from a ruptured salivary gland. CM large, soft, mucous-containing cyst on floor of mouth. Refer to oral surgeon for excision.
Ranula
white verrucous (warty) lesions (individual or clusters) onlips, hard palate, or gingiva. Painless
PE: pain, tingling, burning, with erythema
spread through oral secretions
HPV oral infection
overgrowth of yeast Candida albicans- most common fungus in infect oral cavity
Risk Factors:
inhaled corticosteroids- rinse mouth after
Decreased immunity; Crohn’s, Ulcerative Colitis, DM
Long term use of ABX or corticosteroids
Dentures→ Denture stomatitis
Candida or thrush (yeast)
how to tx Candida or thrush (yeast)
Nystatin- 4-5x/day for 5 days
inflammation of gingiva, bleeding with eating hard foods and tooth care
minor manipulation of gingiva causes localized bleeding
Gingivitis
Inflammation of one or both of the parotid glands; viral infection (paramyxovirus/mumps, HIV)
Bacterial: staph, TB Salivary stones (Sialoliths) Dry mouth-meds (anticholinergics and antihistamines) Fungal infections Malignancies
Risk Factors: older adults, chronic illness, immunocompromised
Parotitis (Severe-IV abx)
Rapid onset Pain and swelling on affected side Painful chewing Fever, Pain into ear- close to ear If Both sides.. prob mumps
Parotitis
mild erythema with little to no exudate. Pharynx appears boggy, swollen, or pale
NO painful/tender lymphadenopathy (unless infectious mononucleosis)
Viral Pharyngitis
Anterior cervical lymph nodes enlarged…. ____
If posterior cervical enlarged ____
anterior = prob group A hemolytic strep
posterior = mumps
group A strep; formation of pus in peritonsillar tissue
Risk Factors: recent strep infection, recurrent tonsillitis, smokers, poor oral hygiene
Peritonsillar Abscess -> ER
Fever, chills, fatigue, malaise, halitosis, dysphagia, severe sore throat, otalgia,
Pain radiating to ear of affected side, Hoarse (“hot potato”) voice, drooling
Trismus (spasms of masticator muscles)
Edema and erythema of peritonsillar tissue & soft palate; covered with exudate→ unilateral
Uvula edematous and displaced to opposite side
Tonsil displaced downward and medially
Peritonsillar Abscess -> ER
What to do with peritonsillar abscess?
MUST REFER IMMEDIATELY for surgical intervention (I&D, needle aspiration, or tonsillectomy)
pain (facial, neck, jaw) at least once/week; limited ability to open mouth wide; painful clicking, popping of jaw
TMJ
soft diet, muscle relaxation, ice, analgesics and antiinflammatory meds. Bite block (plastic splint)
