Stephens Columns Flashcards
Virus with multiple forms of which humans are the only natural reservoir, having 8 total types, all of which cause a primary infection, then remain latent in specific cell types for the life of the individual (Neville 240)
Herpes/Herpetoviridae (HHV)
HHV that has 2 simplexes which are DNA viruses (Neville 240)
HSV-1/HHV-1
This HHV simplex is a DNA virus and is spread predominantly through infected saliva or active perioral lesions. The virus commonly seen in the oral, facial, and ocular areas. Pharynx, intraoral sites, lips, eyes, and skin above the waist are most common sites (Neville 241)
HSV-1/HHV-1
This HSV simplex is a DNA virus and is spread predominantly through sexual contact, involving the genitalia and skin below the waist (Neville 241)
HSV-2/HHV-2
What is the initial exposure of an individual without antibodies to HHV-1 called (Neville 241)
primary infection (also called acute herpetic gingivostomatitis [Neville 242])
What is the common age of onset, the symptomology and the morbidity of an HSV-1/HHV-1 primary infection (Neville 241)
-young age (6mo-5yrs, peaks at 2-3 yrs old[Neville 242]) -Asymptomatic -No significant morbidity
Most frequent site of latency for HSV-1/HHV-1 after primary infection (Neville 241)
trigeminal ganglion
By what means does the HSV-1/HHV-1 virus use to travel from its site of latency to the peripheral skin or mucosa (Neville 241)
via axons of the sensory nerves
Term for the reactivation of HSV-1/HHV-1 infection (Neville 241)
secondary/recurrent/recrudescent HSV-1
Many pts with Secondary/recurrent/recrudescent HSV-1 present the infection how (Neville 241)
asymptomatic viral shedding in the saliva
2 instances when can HSV-1/HHV-1 spread to an uninfected person (Neville 241)
during asymptomatic viral shedding From the symptomatic active lesions
Only stimulant that has been demonstrated unequivocally to induce HSV-1/HHV-1 recurrent lesions (Neville 241)
Ultraviolet light
Almost all HSV primary infections occur from what (Neville 241)
contact with an infected person who is releasing the virus
Usual incubation period after HSV infection (Neville 241)
3-9 days
What is the difference in the presentation of primary infection of those presenting early in life (childhood) versus those presenting later in life (adulthood) (Neville 241)
HSV-1 childhood primary exhibit gingivostomatitis HSV-1 adult primary exhibit pharyngotonsillitis
What decreases the chance of an HSV-2 infection besides not being promiscuous (Neville 241)
having antibodies to HSV-1
HSV-2 initial infections normally occur in what age range (Neville 241)
15-35
HSV infections have been associated with an increase in the risk of presenting what non-infectious process (Nevill 241)
Erythema multiforme
Most common pattern of symptomatic primary HSV infection, 90% by HSV-1 infection. Presentation is abrupt with: Anterior cervical; lymphadenopathy; Chills; Fever (103-105°F); Nausea; Anorexia; Irritability; Sore mouth lesions (Neville 242)
acute herpetic gingivostomatitis (primary herpes)
What will be the manifestation of the sore mouth lesions of acute Herpetic Gingivostomatitis (primary herpes) (Neville 242)
-multiple ulcerations on both free and attached mucosa -Gingiva enlarged, painful, extremely erythematous Punched out lesions along the midfacial free gingival margin can involve labial mucosa and extend perioral
How long will it take for a mild case of acute herpectic gingivostomatis (primary herpes) to resolve (Neville 242)
5-7 days
How will acute herpectic gingivostomatitis (primary herpes) present in an adult (Neville 242)
sore throat; Fever Malaise; Headache; Numerous ulcerations on tonsils and posterior pharynx
Significant cause of pharyngotonsillitis in young adults from higher socioeconomic groups (Neville 243)
HSV, mostly HSV-1, but HSV-2 increasing
This is a recurrence of the HSV infection at the site of primary inoculation or in adjacent areas of surface epithelium supplied by the involved ganglion (Neville 243)
recurrentl herpex simplex infections/secondary herpes/recrudescent herpes
Most common site of recurrence for HSV-1 (Neville 243)
vermillion border and adjacent skin of lips
Clinical name of recurrence of HSV-1 on the vermillion border and adjacent skin of lips (Neville 243)
herpes labialis
Lay term for recurrence of HSV-1 on the vermillion border and adjacent skin of lips (Neville 243)
-cold sore -fever blister
What develops 6-24 hrs prior to herpes labialis (HSV-1 recurrent infection) presenting (Neville 243)
prodromal signs/symptoms: Pain; Burning; Itching; Tingling; Localized warmth; Erythema of involved epithelium
How does Herpes Labialis (HSV-1 recurrent infection) present after the prodrome (Neville 243)
multiple small, erythematous papules develop and form clusters of fluid filled vesicles that rupture and crust within 2 days
How long does it take for healing to occur from Herpes labialis (HSV-1 recurrent infection) (Neville 243)
7-10 days
When are symptoms most severe for Herpes labialis (HSV-1 recurrent infection) (Neville 243)
first 8 hrs
When is the viral replication of Herpes labialis (HSV- 1 recurrent infection) most active (Neville 243)
first 48 hrs
What is the normal recurrenc of Herpes labialis (HSV-1 recurrent infection) (Neville 243)
2 recurrences annually
What is the only mucosa that HSV-1 will recur on: bound down or non-bound down (Neville 244)
keratinized mucosa that is bound down (attached gingival and hard palate)
HSV-1 infection of the thumbs or fingers that can result in paresthesia or permanent scarring (Neville 244)
herpetic whitlow/herpetic paronychia
Which HSV is a risk for newborns, HSV-1 or HSV-2 (Neville 245)
HSV-2 spread through birth canal of infected mother. Baby is safe from HSV-1 as it is spread through saliva and maternal HSV-1 antibodies in the baby protect it for its first 6 months of life outside the womb
List the 8 Herpes viruses and their names or what they cause if it is known (Neville 241)
-HSV-1 oral herpes -HSV-2 genital herpes -HHV-3 Varicella-Zoster virus (VZV) (Chickenpox/shingles) -HHV-4 Epstein-Barr virus (EBV) (mononucleosis) -HHV-5 Cytomegalovirus (CMV) -HHV-6 have roseola pattern on skin -HHV-7 have roseola pattern on skin -HHV-8 Kaposi Sarcoma herpesvirus
Herpex virus has main effects on what cell type (Neville 245)
epithelial cells
antiviral capsule prescription for treatment of herpes during the first 3 symptomatic days (Neville 245, Siversky regimen list )
-Rx Acyclovir 200 mg capsules -Disp: 38 capsules -Sig: Take three (3) stat, then one (1) capsule 5 times a day for 7 days
3 different means to deliver Acyclovir for the treatment of Herpes to accelerate clinical resolution of symptoms (Neville 245, Siversky regimen list)
1) Acyclovir 5% cream 2) Acyclovir 200 mg capsules 3) Acyclovir 5% ointment w/ Dyclonine HCl 1% or Lidocaine 1% compounded
Prescription for Acyclovir 5% cream (Siversky regimen list)
-Rx Acyclovir 5% Cream -Disp: 3 or 15 mg tube -Sig: Apply to affected area six (6) times a day
Prescription for Acyclovir 5% ointment with Dyclonine HCl 1% or Lidocaine 1% Compound (Siversky regimen list)
-Rx Acyclovir 5% ointment with Dyclonine HCl 1% or Lidocaine 1% -Sig:Apply to affected area q2h (start applying prodromal stage)
This is a non-prescription ointment that comes in a 2g tube and is applied to the affected area 5 times a day (Siversky regimen list)
Docosonal (Abreva)
2 antivirals in the family of acyclovir, but who show improved bioavailability and more convenient oral dosing schedules than acyclovir (Neville 247)
Valacyclovir Famciclovir
Prescription for antiviral Famciclovir (Siversky regimen list)
-Rx Famciclovir 125 mg tabs -Disp: 10 tabs -Sig: Take one tab bid for five days
Prescription for antiviral Valacyclovir (Siversky regimen list)
-Rx Valacyclovir 500 mg tables -Disp: 8 tabs -Sig:Take 4 tabs in prodrome and 4 tabs 12 hours later
Why is Penciclovir a better antiviral cream than acyclovir (Neville 247)
Penciclovir’s base allows increased absorption through the vermillion border while acyclovir cream’s base prevents significant absorption
Prescription for Penciclovir cream (Siversky regimen list)
-Rx Penciclovir 1% Cream -Disp: 2 gm tube -Sig: Apply a thin amount to affecte area q2h during waking hours for a period of 4 days (treatment should begin as early as possible, ie. during prodrome or when lesions appear)
Is there a vaccine against HSV-1 or HSV-2 (Neville 248)
No
Holistic treatments for herpes outbreak (Siversky)
-Citrus -Bioflavonoids -Ascorbic Acid 400mg
Prescription for Herpes treatment with Acyclovir (Siversky list too know from Brady Wilde)
-Acyclovir 5% cream -Disp: 3 to 15 gm tube -Sig: Apply to affected area 6 times a day
Prescription for Herpes treatment with Penciclovir (Siversky list too know from Brady Wilde)
-Penciclovir 1% cream -Disp: 2 gm tube -Sig: apply a thin amount to affected area q2h during waking hours for a period of 4 days
When should Penciclovir treatment be initiated (Siversky list too know from Brady Wilde)
begin as early as possible (i.e during prodrome or whne lesions appear)
Prescription for Herpes treatment with Valacyclovir (Siversky list too know from Brady)
-Valacyclovir 500mg tablets -Disp: 8 tabls -Sig: take four tablets in prodrome and four tablets 12 hours later
Can be caused during a candidiasis infections, and is characterized by erythema, fissuring and scling at the angles of the mouth (Neville 216)
Angular Cheilitis
Often occurs alone, typically in older person with reduced VDO and accentuated folds at the corners of the mouth where saliva will tend to pool, causing moisture that favors a yeast infection (Neville 216)
Angular Cheilitis
Most common presentation of bacterial or fungal infections of lips (Neville 304)
Angular Cheilitis
Other causes of angular cheilitis (Neville 304)
-contact dermatitis (secondary to chronic lip licking) -Allergic contact mucocitis -Atopic exzema -Iron deficiency anemia
2 things used to treat angular cheilitis (Siversky)
antifungal and steroids
Prescription for angular cheilitis (Siversky)
-Triamcinolone 0.1% and Nystatin 100,000 units/gram cream (Mycolog II) -Disp: 15 gm tube -Sig: Apply t.i.d. until healing occurs
Why give steroid for angular cheilitis (Siversky)
stop redness
What can be given if angular cheilitis if caused by vitamin deficiency (Siversky)
Vit B supplement
How does an aphthous ulcer present different than recurrent herpes infection (Siversky)
-size, Number, Location -Aphthous is single, large lesion on non-bound tissue
What is the most important thing to tell pts about their aphthous ulcer (Siversky)
it’s recurrent
Are aphthous ulcers painful and do they respond to therapy (Siversky)
Yes and yes
2 methods to treat and aphthous (Siversky)
cautery and steroids
Medication Siversky uses for Chronic Aphthous ulcer treatment (Siversky) (Siversky list to know from Brady Wilde)
Flucinonide (Lidex) .05% gel
Flucinonide prescription for Aphthous ulcer treatment (Siversky list to know from Brady Wilde)
-Flucinonide (Lidex) .05% gel -Disp: 15 or 30 gm tube -Sig: Apply a thin amount 2-3 times daily
Causes of aphthous ulcer (Siversky)
Trauma, stress, allergy to food or material
How common are aphthous ulcers (Siversky)
40% ~1/3 population
Demographic for aphthous ulcers (Neville 333)
children and young adults
Size and time for healing of minor aphthous ulcer (Neville 333)
3-10mm, heal in 7-14 days. 1-5 lesions/episode
Prescription mixture for mouth pain attributed to disease such as aphthous ulcers (Siversky list to know from Brady Wilde)
-Diphenhydramine elixir 12.5mg/5mL w/ Maalox -Disp: equal amounts of each -Sig: Rinse with 1-2 tsp q2h (especially before meals) and expectorate. Refigerate
Siverky’s 2 topical prescriptions for ulcerative disease such as lichen planus (Siversky list to know from Brady Wilde)
Clobetasol propionate .05% gel -Disp: 15 or 30 gm tube -Sig: Apply a thin amount to affected area b.i.d. Dexamethasone elixir .5mg/5mL -Disp: 12-16oz -Sig: Rinse w/ 1 tsp for 2 min b.i.d. – q.i.d. and expectorate
Systemic treatment for ulcerative disease therapy such as Lichen planus, erythema multiform minor or a lot of aphthous at once (Siversky list to know from Brady Wilde)
Prednisone 20 mg tab (for >130 lb adult) Disp: 24 tabs Sig: Take 3 tabs(60mg) in the morning with food for four days. Followed bv 2 tabs (40mg) in the morning with food for four days. Then one tab(20mg) in the morning for 4 days.
What is the difference in the Prednisone prescription for systemic treatment of Lichen planus, erythema multiform minor or a lot of aphthous at once in a pt less than 130 lbs(Siversky list to know from Brady Wilde)
dosage is 1⁄2 (10mg tab) of 130 lb dose, e.g. 30 mg, 20mg, 10 mg, each for 3 days
This is another direct therapy method to treat an aphthous ulcer, and what is the key when doing it (Siversky list to know from Brady Wilde)
Cautery(sulfuric acid[Dibaceterol], silver nitrate, tincture of benzoin). Must have area dry or cautery goes everywhere there is saliva
Indurated is indicative of what process (Siversky)
Cancer
Why is cancer indurated (Siversky)
because the epithelium growing down is harder than the lower connective tissue
Central papillary atrophy appearing as a well demarcated erythematous zone that affects the midline, posterior dorsal tongue and often is asymptomatic. Erythema is usually due to loss of filiform papillae in the area. Can be associated with a localized candidiasis (Neville 216)(Siversky)
Median rhomboid glossitis
Are any medical treatments indicated or Median rhomboid glossitis (Siversky)
no treatment other than brushing
Red patch that cannot be clinically or pathologically diagnosed as any other condition (Neville 397)
Erythroplakia
What should erythroplakia be considered until proven otherwise (Siversky)
Cancer
If the erythroplakia is part of a red/white lesion, which part should be biopsied (Siversky)
the red part because it is closer to the vasculature
% of erythroplakia that are premalignant on biopsy (Siversky)
80-90%
multiple well-demarcated zones or erythema concentrated to the lateral borders of the tongue which is due to atrophy of filiform papillae, and normally surrounded by slightly elevated yellow-white serpentine scalloped borders (Neville 780)
Erythema migrans/geographic tongue/benign migratory glossitis
What are the symptoms of geographic tongue (Neville 780)
can have burning sensation or sensitivity to hor or spicy foods
What is the proper tongue for geopgraphic tongue that isn’t on the tongue, e.g. on the lip (Siversky)
erythema migrans
percent of population with geographic tongue or erythema migrans (Siversky)
2-4%
Gender predilection for geographic tongue/erythema migrans (Neville 779)
F>M 2:1
Localized bony protuberances that arise from the cortical plate that only need to be treated if they bother the patient or for prosthetic regions (Neville 19) (Siversky)
Buccal Exostosis
Benign proliferation of stratified squamous epithelium, resulting in a papillary or verruciform mass. Can be soft, painless, usually pedunculated, exophytic nodue with numerous fingerlike projections that impart a “cauliflower” or wartlike appearance (Neville 362-3)
Papilloma
Does one papilloma mean it is HPV, and what are the characteristic papillomas of HPV (Siversky) (Neville 366)
-No -Condyloma accuminatum(papillomas all over mouth and genitals. Dangerous HPV 16, 18, and 31.
Name it
Papilloma
Reactive tissue growth that commonly occurs beneath a denture(Neville 512)
Name it
Inflammatory papillary hyperplasia? Denture stomatitis
Name it
Buccal exostoses
Name it
Geographic tongue
Name it
Erythroplakia
Name it
Median Rhomboid Glossitis
Name it and Treat it
Aphthous ulcer
Rx: Lidex .05% gel (Flucinonide)
Disp: 15 or 30 gm tube
Sig: Apply a thin amount 2-3 times daily
Name it and treat it
Angular Cheilitis
Rx: Mycolog II (Triamcinolone 0.1% and Nystatin 100,000 units/gram) Disp: 15 gm tube
Sig: Apply t.i.d. until healing occurs
Sebaceous glands that occur on the oral mucosa, highly common, require no treatment (Neville 7)
Name it
Fordyce Granules
Common, chronic dermatologic disease found in middle-aged adults, with purple, puritic, polygonal skin papules, and having 2 overall forms: reticular and erosive. Reticular will have interlacing white lines on the oral mucosa called Striae of Wickam, while the erosive form is symptomatic having atrophic, erythematous areas with central ulcerations of varying degrees with a white border (Nevile 783-4)
Lichen Planus
Gender predilection for Lichen planus (Neville 783)
Key terms for skin lesions associated with Lichen planus (Neville 783)
What are the interlacing white lines of Reticular Lichen planus called (Neville 783)
Name it
Lichen planus, reticular
Name it and 2 ways to treat it
Lichen planus, erosive
Rx Clobetasol propionate .05% gel
Disp: 15 or 30 gm tube
Sig: Apply a thin amount to affected area b.i.d.
Rx Dexamethasone elixir .5 mg/5mL
Disp: 12-16 oz
Sig: Rinse with 1 tsp for 2 mins b.i.d.-q.i.d. and expectorate
Systemic treatment for erosive lichen planus for an adult over 130 lbs(Siversky)
Minute hemorrhages into skin, mucosa, or serosa. Orally can be caused by trauma, mononucleosis, leukemia, anemia, thrombocytopenia(Siversky, Neville 305)
Name it
petechiae
Is lichen planus only caused by a chronic dermatologic disease (Neville 782)
Multiple supernumerary teeth or unerupted teeth are found in what syndrome (Siversky)
Hypophosphatasia disorders could have what dental manifestation (Siversky)
Found at the intraoral opening of a sinus tract from a periapical infection showing a mas of subacutely inflamed granulation tissue (Neville 136)
parulis/gum boil
Name it
Parulis/ gum boil
A lesion in the mouth that is raised, usually ulcerated centrally with rolled borders and feelilng indurated is most likely what disease (Siversky)
Name it
Squamous cell carcinoma
Most common NON-ODONTOGENIC cyst of the oral cavity, can have swelling of anterior palate, drainage and pain, that can have an intermittent history. Radiographic appearance is well-circumscribed radiolucency in or near the midline of the anterior maxilla between and apical to the central incisors. Cyst appears round or oval, sometimes called heart-shaped (Neville 28-29)
Name it
Nasopalatine duct cyst/incisive canal cyst
Will central incisors associated with a nasopalatine duct cyst be vital or non-vital (Siversky)
Vital
Asymptomatic radiolucency below the mandibular canal in the posterior mandible between the molar teeth and the angle of the mandible. Typically well- circumscribed with a sclerotic border. Commonly unilateral (Neville 24)
What is gender predilection for Stafne bone defect (Neville 24)
Name it
Stafne defect
Focal area of increased radiodensity that is of unknown cause and cannot be attributed to any inflammatory, dysplastic, neoplastic or systemic disorder. 90% seen in mandible in the first molar area (Neville 621)
Name it
Idiopathic osteosclerosis
This looks like osteosclerosis but is associated with the apices of teeth with pulpitis(from large carious lesions or deep coronal restorations) or pulpal necrosis. It must be associated with an area of inflammation(Neville 147)
Name it
Condensing osteitis
Tumorlike hyperplasia of fibrous connective tissue that develops in association with the flange of an ill- fitting complete or partial denture (Neville 510)
Name it
Epulis fissuratum
Pt that complains of suddenly forming diastemas and whose radiographs reveal hypercementosis and a cotton wool bony appearance, what disease do they most likely have (Siversky)
Syndrome that has Café Au Lait spots around the mouth (Siversky)
Fibrous dysplasia has what radiographic appearance (Siversky)
Osteosarcoma will have what radiographic appearance (Siversky)
Name it
Osteosarcoma
Malignancy of mesenchymal cells that have ability to produce osteoid or immature bone. This is the most common type of malignancy to originate within bone after hematopoietic neoplasms (Neville 660)
Common age ranges for osteosarcoma (Neville 660)
2 most common symptoms of osteosarcoma (Neville 661)
Idiopathic osteosclerosis, central giant cell granulomas, fibrous dysplasia, cement-osseous dysplasia,ossifying fibromas, osteoma, cementoblastoma, osteosarcoma all have what in common with their pathology
Non-odontogenic jaw tumor that will be Radiolucent, can be multilocular or unilocular, commonly asymptomatic but can result in painless expansion of bone. 60% of cases occur before age 30, majority noted in females, common to anterior portions of the jaw and frequently cross the midline, will cause root resorption(Neville 626)
Name and treat it and differential dx
Central Giant cell granuloma Treat via curettage
differential: brown tumor, ameloblastoma, aneurysmal bone cyst (Radiopedia)
Non-odontogenic Radiolucent jaw tumor common in ages 10-20 yrs, but no younger than 5 and rarely in someone older than 35. Majority in the mandible, in the molar and premolar region. Well delineated RL defect with domelike projections that scallop up between the roots, there is no root resorption and the teeth will be vital. Rarely is there swelling or pain (Neville 632)
Name and treat
Simple bone cyst
Exploratory surgery for diagnosis and curette walls
What are the differentials with a simple bone cyst, i.e. what is being ruled out with exploratory surgery (Neville 634)
Developmental tumorlike condition characterized by replacement of normal bone by excessive proliferation of cellular fibrous connective tissue with most common symptom being a painless swelling. Maxilla more often than mandible. Chief radiographic feature is the ground glass radiopacity . May displace teeth(Neville 635-6)
What will fibrous dysplasia in the mandible commonly displace and in what direction (Neville 636)
What will fibrous dysplasia obliterate and displace in the maxilla (Neville 636)
displace sinus floor, obliterate maxillary sinus
Name this RO
Fibrous dysplasia (ground glass radiopacity) Will stabilize after pt stops growing, or will continue to grow slowly. Surgical reduction
What is the risk associated with fibrous dysplasia (Neville 640)
Asymptomatic non-odontogenic lesions of the tooth bearing areas of the jaw that start as radiolucent but become radiopaque in later stages. Always associated with a vital tooth. In late stage the lesion will be a circumscribed dense calcification surrounded by a narrow radiolucent rim. There are three types, one of which is common in middle-aged African-American women (Neville 641)
Name this radiographic feature if the pt is a middle aged African-American female, and treat
Florid Cemento-osseous dysplasia
Pt has regular recalls to control periodontal disease and prevent tooth loss. If expose dysplasia to oral environment risk an osteomyelitis because the area is hypovascular.
This is a true neoplasm that resembles cement- osseous dysplasia, but this is painless and expansile and not tooth associated. Occur commonly in 30-40 yrs old, majority in mandible in the molar and premolar area. Radiographically appear well definded and unilocular ranging from radiolucent to having radiopacities within(ossifications). Will cause root divergence or resorption (Neville 647)
Name it
Cemento-ossifying fibroma
Benign tumor of mature compact or cancellous bone and appear as circumscribed sclerotic masses (Neville 650)
Name all the individual radiopacities and what syndrome this is associated with
Osteoma
Gardner syndrome
Neoplasm of cementoblasts, commonly arising in the mandible on the molars and premolars, pain and swelling are a common symptom and sign. Will be a radiopaque mass fused to one or more tooth roots and surrounded by a thin radiolucent rim obscuring the outline of the involved roots(Neville 655)
Name it
Cementoblastoma
