TRANS 52 Diseases of the Oral Cavity Flashcards
Hypodontia vs Oligodontia vs anodontia?
Hypodontia - tooth loss except the third molars
Oligo - more than 6 teeth missing
Anodontia - all teeth missing`
is the traumatic removal of teeth.
Exodontia
o The tooth rot because of trauma, fails to develop normally,
resulting in an angular malformation of the root
o The condition is associated with rickets and cretinism
Parang sume-sexy ang ngipin. Happens to kids na
nababagsak.
Dilaceration
Refer if there are just unerupted teeth. If so, refer to the dental
department.
Supernumerary teeth
In severe cases parang nagtatanggal na ang coating.
Enamel hypoplasia
o May be due to antibiotic exposure (tetracycline) prior to
eruption
Tetracycline was the ‘wonder drug’ in the 70s even sepsis
neonatorum cases. Upon eruption of the teeth, may
discoloration agad. It’s not as used today save for
autoimmune problems in adults.
Enamel discoloration`
is the general term for any inflammatory disorder of the oral mucosa
• It can be associated with the following diseases:
o Gingivitis
o Periodontitis (pyorrhea)
o Periodontosis: chronic degenerative destruction of the periodontal tissue
o Acute necrotizing ulcerative gingivitis
o Herpetic gingivostomatitis and herpes labialis
o Herpangina (Group A Coxsackievirus)
o Noma (acute necrotizing gingivitis)
o Bacterial stomatitis
o Thrush (Candida albicans)
Stomatitis
How to differentiate leukoplakia and thrush?
On PE: you will see white spots on the mouth. To know against leukoplakia: scrape off with a tongue blade. Kapag natanggal, fungal infection; kapag nag-bleed, baka mass sa tongue/cancer.
causative agent of periodontitis? herpangina? Thrush Actinomycoses Histoplasmosis?
pyorrhea? Group A cocksackievirus Candida albicans Filiform bacillus histoplasma capsylatum
o Recurrent aphthous ulcers
o Multiple, large deep ulcers that can cause excessive scarring
Sutton Disease
Pemphigus vulgaris vs Pemphigoid
• Pemphigus vulgaris
o Intraepidermoid bullae
• Pemphigoid
o Subepidermoid bullae
o Differentiation from pemphigus requires histologic examination with staining for basement membrane
Mas malalim, mas mahirap ang treatment and management.
A combination of symptoms: Oral ulcerations, conjunctivitis, iritis, and urethritis
• Behcet Disease
o Lack of Vitamin B12
o tongue may show lobulations on surface
o In advance cases: be shiny, smooth and red
o Oral mucosa may exhibit an irregular erythema
Before they would place leech on the tongue para mapalabas ang dugo.
• Pernicious Anemia
o Oral mucosa is ash gray (may be associated with Plummer Vinson Syndrome)
o Tongue is smooth and devoid of papillae
• Iron deficiency anemia
Upon PE, parang baliktad sila ng pernicious anemia. Malaki ang dila mo in both pero sa IDA ay smooth. Pag may nakita kang lobulations, pernicious anemia.
o Oral mucosa has diffuse pallor and cyanosis
• Thalassemia (Mediterranean Anemia)
o Oral mucosa is bright blue-red with gingival bleeding
For my patient with 24-hr bleeding, it might be hemangioma. I ordered a CT for my patient who refused admission. Remember to put this on your chart especially in emergency cases.
• Polycythemia
o Hereditary hemorrhagic telangiectasia
o Forms spider-like blood vessels or angiomatous appearing lesions in the oral mucosa, tongue, and nasal mucosa and is associated with recurrent epistaxis
o The GI tract may be involved, and transfusion may be required
Osler-Weber-Rendu Disease
o Port wine stain of the face, oral cavity, or tongue associated with vascular malformation of the meninges and cerebral cortex
Sturge-Weber Syndrome
o Purpura due to marked decrease in platelets from a variety of causes
o Initial manifestations are often petechia and ecchymosis
Remember to differentiate among purpura, Koplik spots, and dengue.
Thrombocytopenic purpura
Usually in age 40, may ulcerations na in pre-menopausal women.
Clues: hot flushes, burning sensation kahit lagyan na ng yelo
o Senile atrophy
o Dry oral mucosa with burning sensation, diffuse erythema, shiny mucosa, and occasionally fissuring in the melobuccal fold
• Menopausal gingivostomatitis
what nutritional deficiency? atrophic glossitis, angular cheilosis, gingivostomatitis
Riboflavin:
what nutritional deficiency? angular cheilosis
- Pyridoxine: angular cheilosis
* Nicotine acid: angular cheilosis
gingivitis (bleeding gums)/ what nutritional deficiency?
Vitamin C
o Often presents as violaceous macules on the oral mucosa
Kaposi Sarcoma
o Physiologic pigmentation
o Often seen as dark patches of the oral mucosa
Differentiate between melanosis and nicotine patch. Ask if the px is a smoker. If yes and malakas, it might be the latter.
Melanosis
o Inadvertent tattoo of gingiva from dental amalgam introduced through mucosal laceration
Amalgam tatoo
o Melanotic macules periorally
Similar to melanosis, but since macules, medyo maliit. Also differentiate this from foot and mouth disease which also has ulcerations.
Peutz-Jeghers Syndrome
o Black
Expect this in patients from the mining industry.
Bismuth
o Blue-gray line (Burton Line) that follows margin of gingiva
Lead
o Koplik Spots (pale, round spots on erythematous base) seen on buccal and lingual mucosa
Again, differentiate from dengue and purpura.
Measles (Rubeola)
o Strawberry tongue what childhood disease?
Scarlet fever/ kawasaki diseasea
o Red plaque
o Granular erythematous area
o Often encountered in association with leukoplakia (nodular leukoplakia)
o 50% will demonstrate severe dysplasia or carcinoma in situ on biopsy
Erythroplakia
o White plaque
o White hyperkeratotic lesion that may or may not be associated with dysplastic change on histologic exam
o Occurs most frequently on the lip (vermillion_ and then in the descending order of frequently on the buccal mucosa,
Leukoplakia
o Is a smooth reddish midline area of tongue devoid of papillae
o It is a developmental anomaly, and may be associated with candida overgrowth
Usually after oral thrush kahit na napagaling na ang patient, mawawala for a time pero babalik din ang papillae. In median rhomoid glossitis, hindi na babalik.
Median rhomboid glossitis
o Painless pinpoint yellow nodules that occur bilaterally on the posterior buccal mucosa
o These represent enlarged ectopic sebaceous gland and are a benign developmental anomaly
This is a benign condition.
Fordyce granules
(relative macroglossia due to micrognathia)
o Pierre Robin
o Benign bony exostoses commonly seen on medial aspect of anterior mandible
Mandibular otri
o Presents as a circumscribed radiolucency with smooth borders, occurring around the corner of unerupted teeth in kids, adolescents, and young adults
o Radiographically it resembles a dentigerous cyst
Odontogenic Fibroma
o Is a neoplasm of enamel origin that presents in the 3rd and 4th decade
o Most common site is the mandible, especially in the molar region
o Tumors are slow growing and painless, expanding surrounding bone
o Treatment is excision
Ameloblastoma
o Are a broad class of lesions that form cementum (bone like connective tissue that covers tooth root)
o Tumors usually arise at the tip of the tooth roots in young adults
o The radiographic appearance can vary from radiolucent to densely radiopaque
o Treatment is simple enucleation
Cementomas
o Is a tumor composed of ameloblasts (enamel) and odontoblasts (dentin)
o It appears as irregular radiopaque mass, often between tooth roots and is associated with unerupted teeth
o Simple enucleation is sufficient
Odontoma
o Is a well encapsulated follicular cysts, occurring most commonly in the anterior maxilla of adolescent girls in association with impacted teeth
o A rare malignant variant exists
o Treatment is excision
Adenoameloblastoma
o Rapidly growing tumor with local pain and swelling
o 10-25 years of age
o Mandible is the most common site in head and neck
o Tx: radiation and chemotherapy
o 50% survival
• Ewing Sarcoma
o Fast growing, aggressive malignant tumor of the bone
o Occurs primarily in adolescents and young adults
o Survival of mandibular variant better than long bone
o Tx: surgical – combined therapy often utilized
Osteogenic Sarcoma
o Most common, called “perapical cyst” when involves the tooth root
o Commonly caused by dental infection and is usually asymptomatic
o Presents a radiolucent area on xray
o Tx: extraction or root canal therapy
Radicular Cyst
o Development abnormality caused by a defect in enamel formation
o Always associated with an unerupted tooth crown
o Most common in the mandibular third molar or maxillary cuspid
o Ameloblastoma formation occurs in the cyst wall
• Dentigerous (follicular) Cyst
o Mimics dentigerous cysts if associated with a tooth rooth
o If not it is called a “primordial cyst”
o Diagnosis is based on histology
o Tx: excision and curettage
o High rate of recurrence
Odontogenic Keratocyst
o Due to hyperplasia of filiform papillae
o It may be black, blue, brown, or white depending on microflora and nicotine staining, and is often associated with candida overgrowth
Hairy Tongue
o Non-specific term for tumor or tumor-like masses of the gingival, often pyogenic granuloma
o Common in pregnancy
o Congenital epulis is rare and resembles a granular myoblastoma
o A giant cell epulis (giant cell reparative granuloma) is more common and histologic examination demonstrates reticular and fibrous connective tissue with numerous giant cells
o Radiographs show cuffing or sclerotic margins of bone
Epulis
o Is a mucocoele of the sublingual gland that presents in the floor of the mouth
o If it penetrates the mylohyoid muscle and presents as a soft submental neck mass it is termed as “Plunging Ranula”
o Excision should include the entire sublingual gland in order to prevent recurrence, with care taken to protect the submandibular duct and lingual nerve
Ranula
o Benign excessive bone growth in midline of palate that continues to enlarge beyond puberty
o Occasionally, it must be removed in order to prevent denture irritation
Meron tayong overproduction of your bone or bony overgrowth in your palatal area
Torus Palatini
o Due to failure of fusion, and is associated with a characteristic voice change and nasal regurgitation of liquids
o A submucous cleft may be present
o Eustachian tube disorder is due to failure of tensor veli palatine to open ET on swallowing
Cleft palate
▪ Swelling of the uvula often in association with acute bacterial tonsillitis
▪ Uvular swelling can also occur with trauma (heroic snoring, burn from hot food or drink)
Quincke disease
▪ Can occur as familial (C1 esterase deficiency), allergic, or due to ACE inhibitor
▪ Severe swelling may be preceded by sentinel swelling
▪ Tracheotomy may be required
Angioneurotic Edema
White particles trapped in between your crypts, ito yung parang hugas bigas na malambot na mabaho. It can cause bad breath. Dati inooperahan naming isa isa pero pag may ganyan, it’s highly recurrent sinusuggest nalang naming sa patient to undergo tonsillectomy.
Tonsillolith
This is a true emergency for an ENT kasi oropharynx is the common passage of your air and food. So, it can cause blockage, baka di makahinga. Pag namaga ang iyong palate, icocompromise yung airway.
Peritonsillar Abscess
Etiology of acute tonsillitis?
o Group A beta hemolytic streptococci (GABHS)
o Haemophilus influenza
o Streptococcus pneumoniae
o Staphylococci (with dehydration, antibiotics)
o Tuberculosis (in immunocompromised)
Pus located deep to tonsil capsule between tonsil and superior constrictor muscle
• Presents with deviation of the tonsil and uvula toward midline, swelling of soft palate, often with trismus
ACUTE PERITONSILLAR ABSCESS
Eagle syndrome
Pain due to elongated styloid process
Diba bird? Pag umiinom sila, tumitingala like an eagle. So, kapag tumingala yung tip of the styloid process natotouch yung tissues of the neck specifically your SCM, so, nasasaktan. Pag tumingala, masakit.
Smooth soft tissue mass on the membranous vocal fold, sessile or pedunculated
• Histology:
o Out-pouching of mucosa, distended by edema and loose
stroma
vocal cord polyp
polyp primary symptom
Hoarseness, large polyps can cause dyspnea
o Bleeding into polyp can cause sudden enlargement
Laryngeal ulcers and granulomas typically appear on
on the vocal process of the arytenoid cartilage, but may occasionally be seen on the free edge of the vocal fold
Positive Jackson’s sign
Positive Jackson’s sign or pooling of the saliva, di makalunok
These are subtle lesions that can significantly impair vocal fold vibration and hence, the voice.
• Etiology is not certain but can be congenital or acquired by vocal trauma
• Vocal impairment is due to the mass lesion, as well as deficiency of lamina propria
VOCAL CYSTS AND SULCI
cyst versus sulci vs psudocyst
Cysts: epithelial lined spaces and may be mucus retention or epidermoid
• Sulci: two types include epithelial lined pocket (could be a ruptured cyst) or an area of deficient lamina propria (sulcus vergeture)
Pseudocyst: submucosal collections of scar or connective tissue, not encapsulated by epithelium, and probably the result of chronic trauma
Air-filled dilation of the appendix of the ventricle
• May also be fluid-filled or infected
LARYNGOCELE
internal laryngocele vs external
• An internal laryngocele is totally within the thyroid cartilage
framework
• And external laryngocele extends through the thyrohyoid
membrane and may present as a mass in the neck • In a combined lesion, there is dilation in both areas
now to differentiate laryngocele with branchial cleft cyst?
Need na madifferentiate ito with branchial cleft cysts so diba
pag nag aspirate ka sa branchial cleft cyst, meron kang milky fluid substance since associated sya with URTI. Pero sa laryngocele, hangin lang maaspirate mo.
This is a slowly growing tumor composed mainly of hyaline cartilage
• More common in men
• Most frequent site of origin is the internal aspect of the
posterior plate of the cricoid cartilage followed by the thyroid,
arytenoid, and epiglottis
CHONDROMA
whta is the sign in xray for epiglotitis?
Thumb print sign
Most common etiologic agent of epiglotitis?
Hemophilus influenza
o Sore throat, dysphagia, and drooling, fever, stridor, dyspnea (relieved somewhat by leaning forward), “hot potato” voice
what disease?
Epiglotitis
• Primarily occurs in children between the ages of 1to 3 years
• Cause
o Probable viral in etiology
o Parainfluenza types 1 to 4 have been isolated frequently
o H. influenzae, streptococci, and pneumococci are often cultured
• Symptoms
o Congestion and barking cough with hoarseness progressing to stridor
o Suprasternal retractions and accessory muscle use
o Agitation and increased pulse are signs of hypercarbia
o Circumoral pallor and cyanosis are late signs
CROUP (ACUTE LARYNGOTRACHEOBRONCHITIS)
