Path I Flashcards
epithelium type of oral cavity
squamous, focally keratinized
what is in the pulp of our teeth
nerves, capillaries, lymphatics, CT
what makes up cementum of our teeth
hydrozyapatite and collagen that is anchored by the periodontal ligament
role of periodontal ligament
anchors cementum
procides nutrients and vascularity for cemetoblasts
mulipotential cells
what makes up dentin of teeth
odontoblasts
what are the primary colonizers of the oral cavity
strep mutans
actinomyces
neisseria
veillonella
what are the secondary colonizeers of the oral cavity
fusobacterium nucleatum
prevotella intermedia
porphyromonas gingivalis
capnocytophaga species
what are the late colonizers of the oral cavity
campylobacter rectus eikenella corrodens actinobacillus actinomyetem comitans treponema
supragingival plaques are usually from what
dental caries- S mutans
endodontic infection
periapical abscess
subgingival plaques are usually from what
peridontal infection gingivitis- P intermedia Peridontitis: R gingivitis in adults, actinomyetem comitans in children pericoronitis fascial space infection osteomyelitis
what dissolves the enamel on teeth
plaque+lactic acid+lowpH
what are major risk factors for destroying enamel
frequency of sugar exposure processed foods xerostomia medications sjogren disease
complications from dental caries
periosteal abscess, fistula to skin
radicular periapical cyst
sings of cavernous sinus thrombosis
HA, lateral gaze palsy and horizontal diplopia
What is ludwigs angina
cystic mass or inflammation form carie that causes tongue to be pushed on airway
what is gingivitis
inflammation of the gingiva
erythema, edema, bleeding
what type of microbes are found on peridontium in active periodontitis
anaerobes and microaerophillic gram -
names of top culprits in adult periodontitis
actinobaccilus
actinomycetem comitans
prevotella intermedia
what are signs of periodontitis
loose teeth, infection, bad breath, tooth loss
what classifies moderate and severe periodontal disease
moderate- 4-5 mm connection lost
severe >6 mm connection loss
what parts of teeth are affected by periodonitits
cementum, periodontal ligament and alveolar bone
what systemic diseases can cause to periodontisis
AIDS leukemia DM sarcoidosis congenital:kostmanns disease and chediak higashi
what is kostmanns disease
severe congenital neutropenia
LL37 protein
what is chediak higashi syndrome
agranulocytosis, cycli neutropenia
what is an apthous ulcer
canker sore
painful ulceration of oral cavity mucosa
single ulcer with red halow surrounding central white-yellowish membrane
What are the 2 herpes viruses
HSV-1 orofacial
HSV-2 genital
test for herpes
Tzanck, multinucleated giant cells
what are the 2 patterns of initial HSV-1 infection
90% asymptomatic or mild transient orofacial blisters
10% acute herpetic gingivostomatitis- numerous mucosal ulcers
what does oral candidiasis look like
white cheesy, velvety
easily scraped away with little or no bleeding
what will candida show on PAS stain
pseudo-hyphae
2 factors that can lead to oral hairy leukoplakia?
what does it look like?
immune suppression (HIV) + EBV lateral border of tongue, does NOT scrape off
What can cause a black hairy tongue
smoking and bad oral hygiene
what are you testing when using heterophile Ab test
EBV-monospot test
if agglutinates, have EBV
what is an irritation fibroma
result in repetitive trauma
reactive fibroelastic tissue
Tx with surgical excision
usually on tongue or buccal mucosa
what type of tissue is pyogenic granuloma
reactive granulation tissuew
pyogenic granulomas are common in what patients
pregnancy
and in children
95% of oral cavity cancers are what?
the other 5%?
95- squamous cell carcinoma
5- adenocarcinomas of salivary glands
70% HPC in oral pharynx is what type
type 16
describe progression of squamous cell carcinoma in oral cavity
hyperkeratosis
low grad dysplasia
high grade dysplasia (carcinoma in situ)
invasive carcinoma
what decides whether cancer has capacity to metastasize
crosses BM
what is leukoplakia
white patch that cannot be scraped off
d/t keratin
what must you do inpatient with hyperkeratosis in mouth
biopsy to evaluate if has premalignant changes
what is erythroplakia
red patch
more ominous becuase eroded mucosa
90% dysplasia or CIS, some SCC
oral cavity SCC are at what stage usually
II-III
what is stage II SCC
> 2 cm, <4 cm no spread
stage III SCC
> 4cm or spread to one cervical lymph
stage IV SCC
multiple or node>3cm, spread to other tissues or metastasized
Tx stage I-II SCC of oral cavity
wide local excision or RT
Tx stage III-IV SCC or oral cavity
excision + RT +/- chemo
what does SCC look like hist from oral cavity
keratin pearls
HPV assoc tumors of oral cavity have better or worse prognosis?
better
tumors found in salivary glands are more likely benign or malignant?
benign
clinical presentation of mump
acute onset b/l tender sself limited swelling of parotid or other salivary glands
2+ days
complications from mumps
testicular inflammation– sterility
distribution of sjogren syndrome
9F:1M peaks at mid 20s and mid 50s
auto-immune etiology
what is in mild form of sjogrens
dry eyes and mouth
what is severe form sjogrens
dry eyes and mouth
florid salivary gland enlargement, adenopathy, vaginal dryness, joint dryness
risk of NHL in 5%
What Ab do you look for in Sjogrens
SS-A Ro
SS-B La
what is angular cheilitis
corners of mouth are dry
seen in sjogrens
what is the most common lesion of salivary glands
mucocele, mucous retention cyst
causes of mucoceles
blockage or rupture of minor salivary gland duct leading to saliva blockage, pooling and distention
increased tension leakage into adjacent CT
most common site of mucocele
lower lip from trauma
Tx mucocele
complete excision that includes mucocele and source minor salivary gland lobule
what is a sialolith
aggregation of dehydrated mucous usually from blockage at terminal end of duct
steps leading to bacterial sialadenitis
duct obstruction (unilateral)
stasis
bacteria cause inflammation
acute process leads to chronic inflammation and gland destruction and fibrosis
what are the benign tumors of salivary glands
pleomorphic adenoma (mixed) warthin tumor
what are the common malignant tumors of salivary glands
mucoepidermoid carcinoma
adenocarcinoma
adenoid cystic carcinoma
where are pleomorphic adenomas found? what do they arise from?
parotid, submandibular/sublingual
arises from multipotential basal myoepithelial cells
what tumor has 2 cell types but is benign
pleomorphic adenoma
best course of action if find a mixed adenoma
follow closely because potential to become malignant
what is a warthin tumor
papillary cystadenoma lymphomatosum
parotid
describe patients more liley to have warthin tumor
M in 50s-60s that smokes
characteristic histo of warthin tumor
double layer eosinophilic epithelial cells over lymphoid stroma
predominant site of mucoepidermoid carcinoma
parotid
what is most important prognostically for mucoepidermoid carcinoma
the grade
low grade is locally aggressibe and rarely metastasizes
high grade is invasive and frequently metastasizes
tumor of adenoid cystic carcinoma infiltrates where
peripheral nerve making it hard to Tx because there are skip or non-contiguous extensions
