Week 2 'Mouth/Throat/Neck' UNF up to Enlarged tongue Flashcards
Xerostomia
What is it?
What causes it?
Dryness of mouth
Caused by dehydration, mouth breathing, diuretics, salivary dz, sioliths
Gingiva
what does it normally look like?
What would painful swelling in gums possibly indicate?
Normally smooth, firm, and contoured around teeth
painful swelling of gums could possibly indicate tooth abcess
What does a dark line on the gingiva indicate?
heavy metal poisoning
What type of laboratory tests might you use for oral cavity/mouth diagnostics?
CBC
CMP (chem. screen)
Rapid strep (check for strep pharyngitis)
Monospot (check for mononucleosis)
Throat culture
B12 levels (B12 deficiency can cause _____ on the tongue)
Lesion biopsy (persisting lesion should be biopsied)
What is Bruxism?
Clenching and grinding of the teeth wears down dental crown, loosens teeth
A hard palate petechia indicates:
petechia (broken capillary blood vessel), seen in strep infx. and suction
Soft palate should elevate uniformly when patient says “ahhhh”. If it doesn’t you might consider….
CN IX, X
Check uvula for….during exam
inflammation, deviation
Tongue movements are controlled by what nerve?
CN XII, Hypoglossal N.
AN enlarged tongue can be caused by….
dentures, inflammation, myxedema, etc…
myxedema
swelling of the skin and underlying tissues giving a waxy consistency, typical of patients with underactive thyroid glands.
Oral SCC (carcinoma of the lips) etiology: Lesion present? Risk of metastasis? Dx?
etiology: tobacco, alcohol, sunlight, poor oral hygiene, or poorly fitting dentures
Lesion present: painless, sharply demarcated, elevated, indurated border with ulcerated base, may be verrucous or plaque like (usu found in mucocutaneous jct of lips: where lips turn into face skin, aka vermilion border)
-lesion is slow growing, fails to heal, can bleed
HIgh risk of metastasis
Dx: biopsy
Mucocele
What is it?
Location?
Etiology?
Soft cyst, mucin-filled cavity with mucous glands lining the epithelium
Common on lips, under tongue
Etiology: minor injury to ductal system of minor labial or sublingual salivary gland, by trauma
Mucocele
signs and sxs
Thick, mucus-type caliva produced by the damged gland creates a clear or bluish bubble of various size, movable, cystic, may rupture. Bleeding may occur with further damage, lesion may then look red or purple.
History of enlargement, breaking, and shrinkage is fairly common. Can persist, rarely goes away on its own (dentists can surgically remove)
Cheilitis
What is it in general terms?
Etiology:
Risks?
Erythema and scaling of the lips “chapped lips”
Etiology: Use of retinoids (vitamer of Vit A), wind burn, allergies, chronic lip licking
Risks: can become secondarily infected
Angular cheilitis
Signs and Sxs:
Etiology:
Lab: (you should assess it for a ______ infx, using a ______ prep)
Note: may also be part of a group of sxs in ____________.
signs and sxs: deep cracks at labial commisure, if severe can split or bleed, form shallow ulcers. May become infected by Candida albicans, Staph aureus; often bilateral
Etiology:
Elderly-ill fitting dentures, loss of teeth changing bite, sicca (dry mouth)
Poor oral hygiene
Nutritional deficiencies, esp. vit B (Riboflavin B2, Cyanocobalamin B12), and iron deficiency anemia (due to poor diet, malabsorption)
Irritant or allergic rxn to oral hygiene or denture material
Lab: KOH prep to assess for Candida infx
Note: May also be part of a group of Sxs in Plummer-Vinson syndrome
What does Ovoid mean?
egg shaped; “oval”
Oral Lichen Planus
What is it?
Etiology:
If chronic it can increase the risk for _________.
Non-erosive lesion: usu painless, vary from lace-like white patches/papules/streaks (Wickham striae) on buccal mucosa to erosions on gingival margin. If painful can interefere with eating. Not contagious
Etiology: unknown. Possible drug rxn. Hep C, worse with stress
An erosive form can erupt into violet papules with white lines or spots, usually on the genitalia, lower back, ankles and anterior lower legs; pruritus;
If chronic it can increase the risk for oral cancer.
Leukoplakia What is it? Etiology: Signs and Sxs: Forms vary: Color variations: PE: Diagnosis: DDx:
White patches (patches are not raised) or plaque (plaques are raised?) on the oral mucosa that CANNOT be rubbed off
- considered precancerous hyperplasia of the squamous epithelium. Up to 20% of lesions will progress to CA in 10yr
- Also seen in inflammatory conditions not associated with malignancy
Etiology: presumptive factors include: trauma from biting, dentures, tobacco use, oral sepsis, syphilis, local irritation, alcohol, vit deficiency, endocrine disturbances, dental galvanism, AIDS
SSxs: Located on tongue, mandibular alveolar ridge and buccal mucosa in ~50%
Also-palate, maxilllary alveolar ridge, floor of mouth, retromolar regions
Forms vary: nonpalpable, faintly translucent white areas to thick, fissured, papillomatous, inderated lesions.
Surface is often shriveled in appearance and may feel rough on palpation. Can look like “flaking white paint”
Color variants:white, gray, yellowish-white, brownish-gray (tobacco)
PE: lesion CANNOT BE WIPED AWAY; check for cervical LA, may indicate malignant changes
Dx: Biopsy to obtain a definitive diagnosis, multiple samples if large lesions
DDx: candidiasis and aspirin burn (CAN be wiped away with gauze)
How is candida different from leukoplakia?
Candida (thrush) can be brushed off
Erythroplakia
What is it?
Etiology:
Risk factors:
Red macule or plaque with well demarcated edges with soft texture; Often on floor of mouth, tongue, palate
Etiology: unknown; but considered a type of epithelial dysplasia, thus pre-cancerous(cancer found in 40% of cases. Biopsy needed!)
Risk factors: smoking, alcohol
Breath odor is aka….
it is indicative of….
Halitosis, bad breath, is indicative of local or systemic disease: gingiva smoking diabetic ketoacidosis--sweet/alcohol Liver disease--faintly sulfurous Renal Failure--amionia
Fetor Oris- starts in the mouth, associated with appendicitis
Oral squamous Cell Carcinoma (carcinoma in oral mouth)
- __% are smokers, _______ is also a risk factor
- Location
- associated with ______ infection
SSxs:
~30,000 in US each year; 90% are smokers, alcohol is also a risk factor
-Subset of SCC associated with HPV-16 infection
-Most are on floor of mouth or on the lateral and ventral surfaces of tongue. Also lip, palate, tongue
-Associated with HPV-16 infection
Most on floor of mouth or on the lateral and ventral surfaces of tongue. Also lip, palate
SSxs: May appear as area of erythroplakia or leukoplakia;
Variants: exophytic or ulcerated. both variants are indurated with a rolled border
Early lesion may be asymptomatic, often painful
metastic mass (non-tender) in neck may be the first symptom
Biopsy any persistant papules, plaques, erosions or ulcers
Oral Melanoma
Concerning signs on pigmented lesions:
DDX:
Pigmented lesions with concerning signs: asymmetry, irrgular borders, variable coloration, increasing diameter; lesion will not blanch
Often diagnosed at later stages
DDX: Melanosis–symmetric lesions in individuals with dark skin
Oral melanotic macules–symmetric, stable, sharply delimited dark macules on lips or oral mucosa
Fordyce’s spots (granules)
Benign neoplasms from sebaceous glands (sebaceous choristomas)
Most common 20-30 years; M=F
Signs and Sxs:
Asymptomatic, multiple, white to yellow, 1-2mm papules, often occurring confluent cluster
Most common on the vermilion/buccal mucosal border. Also on the inner surface of the lips, the retromolar region, tongue, gingiva, frenulum linguae or palate
DDX: candida albicans (candida lesions wipe off, but Fordyce’s granules do not
Stomatitis
What is it?
Causes:
Inflammation of oral tissue Causes: -Infx (Strep, candida, Corynebacterium, syphilis, TB, measles, Varicella-zoster virus, fungus, etc...) -Vit deficiency: vit B and C, iron -Mechanical trauma (poorly fitting dentures, improper nipples on bottles) -alcohol -tobacco -hot/spicy foods/drinks -chemicals -hypersensitivity rxn
Oral Candidiasis
Risk factors:
SSX:
DX: confirmed with….
“Thrush” or “moiliasis”
Common oral fungal (yeast) infection by Candida albicans, C glabrata, C tropicalis
Risk factors: denture-wearers, diabetics, use of antibiotics, exposure to chemotherapy or radiation, HIV/AIDS, use of inhaled glucocorticoids (asthmatics); common in infants
SSX: Lesion: slightly raised soft white plaques (look like milk curds) that are EASILY WIPED AWAY, causing bleeding
- May have burning sensation
- Mouth appears dry (xerostomia)
Dx: confirmed with KOH prep
**recurrent, persistent, extensive disease warrants immune status evaluation
Recurrent Aphthous Atomatitis What is it called in normal terms? Etiology: SSxs: DDX:
“canker sores”
Acute, painful, recurring, solitary or multiple necrotizing ulcerations of the oral mucosa
Possibly T-cell mediated localized destruction of oral mucosa
Etiology: Provocations (exact cause is umknown)
- Trauma is the most common trigger:
- -Physical: toothbrush abrasions, laceration by sharp foods/objects, biting, dental braces
- -Chemical irritants or thermal injury (coffee, tea), foaming agent in toothpaste
- Food allergies
- Deficiencies in B12, iron, and folic acid
- stress, illness, fatigue
- Immunodeficiency
- Neutropenia–history of taking antimetabolites
- Hormonal changes
- Associate w/ celiac disease and IBD
SSxs:
Painful lesions, occasionally have prodromal burning or tingling
Ulcers are shallow, round to oveal with a grayish base, with a red border
Occur on non-keratinized, moveable mucosa; buccal and labial mucosa, buccal and lingual sulci, ventral tongue, soft palate and floor of mouth; some have 2-4 outbreaks/yr, others have continuous
DDX: secondary herpetic ulceration- history of vesicles prededing the ulcers
Trauma, pemphigus vulgaris and cicatricial pemphigoid
Systemic disorders: Crohn’s dz, Neutropenia and sprue
Herpetic Gingivostomatitis: Commonly called: Triggers: SSxs: Lab: DDX:
“cold sore” caused by HSV-1 infx
Painful eruptions of the unmovable oral mucosa and vermilion border
Primary infx of HSV-1, common in children
Triggers: trauma, emotional stress
Signs and Sxs: often a prodrome of pain, burning, tingling; also fever, malaise, LA, painful eating, Eruption fo multiple interoral vesicular lesions and erosions, erythematous base, crusting; Self limited in 1-2 wks in most cases
Kids: fever, LA, drooling, decr. oral intake due to pain (watch for dehydration)
Recurrence is common
Lab: tzank smear, direct immunofluorescence smear, or viral culture
DDX: aphtous stomatitis, erythema multiforme, drug eruptions, pemphigus
Oral Erythema Multiforme What is it? SSxs: Locations on body: DDX:
Hypersensitivity rxn to HSV, other organisms (Mycoplasma pneumoniae), drugs or idiopathic with skin lesions and mucosal involvement
SSx: Painful stomatitis, sudden onset of diffuse hemorrhagic visicles and bullae with erythematous base, on lips/mucosa
Bullae rupture leaving raw, painful, friable surfaces, then form crusts
May be Prodrome: sinusitis, rhinitis
may see a high fever for 4-5 days, and severe systemic symptoms
Other areas of body- maculopapular erythematous lesions (target lesions) form symmetrically on the hands, arms, feet, legs, face, and neck and possibly, in the eyes and on the genitalia
DDX: aphthous stomatitis, allergic stomatitis, pemphigus, herpes
Chancre: Lesion: SSX: PE: be sure to look for... LAB:
Lesion: painless ulceration formed during the primary stage of syphili, ~21 days after the initial exposure to Treponema pallidum
-these ulcers usu form on or around the lips, tongue, also anus, penis, and vagina
SSX: Painless single ulcerated lesion, indurated border, no central necrotic tissue
Tender cervical LA
Chancres typically last 2 wks to 3 months w/ out treatment
PE: be sure to look for genital lesions as well
Lab: PCR serology
Angioedema
What is it?
Signs and symptoms:
Acute edema (swelling) of the skin, mucosa (mouth, throat, tongue) and submucosal tissues Rapid onset (over the period of minutes to several hours) Urticaria (itchy raised bumps) may develop if the angioedema is related to allergy Hand swelling common
Etiology:
1) Allergic (most common) not IgE mediated
2) Infection or Illness: autoimmune disoreders, leukemia
Signs and Sxs: Painless, non-pruritic (if non-allergic), nonpitting, and well-circumscribed areas of edema
from increased vascular permeability.
May progress to complete airway obstruction and death caused by laryngeal edema.
May be chronic when lasting more than 3 weeks
Palatal or Mandibular Torus
What is it?
M:F ratio?
Age of peak incidence?
basically growth of bone on the upper palate (most common location)
Non-neoplastic, slowly growing nodular protruberance of bone. Of little clinical significance, except with interference with denture construction and placement. Likely hereditary
Incidence F > M (2:1). Peak incidence occurs shortly before age 30
Hemangioma What is it? M:F ratio? SSxs: Most common sites: DDX:
Proliferation of blood vessels, often congenital
F>M 2:1
Signs and Sxs:
Lesions are flat or raised, with a deep red or bluish-red color
Most common sites: lips, tongue, buccal mucosa or palate. Because of location, frequently traumatized and can undergo ulceration and secondary infx.
DDX: Arteriovenous fistula: more likely if history of trauma to the area of the lesion
Papilloma Etiology: SSxs: Locations: DDX:
Etiology: some oral papillomas are associated with the same human papillomavirus (HPV) subtype that causes cutaneous warts
Signs and Sxs: Asymptomatic, well-circumscribed, usually pedunculated benign growths with numerous, small finger-like projections (papillary or verrucal)
Generally
Lipoma
What is it?
Painless,Benign mass filled with fatty material on cheek or tongue, since it’s fatty it will have a yellowish color, soft, tender
May affect speech if large
May be hereditary component (familial multiple lipomatosis); may develop in area of trauma
Salivary Glands
- Sialadenitis:
- Sialolithiasis:
- Sialadenitis: Benign swelling seen in many systemic diseases (ex: hepatic cirrhosis, sarcoidosis, neoplasms, infections (mumps)
Usu pain with mumps, malignancy and infx; others may be painless - Sialolithiasis: Salivary duct stones, most common in the submandibular glands
Pain and swelling associated with eating
Salivary Glands
- Sjogren’s Syndrome:
- Xerostomia:
- Sjorgren’s Syndrome: Systemic inflammation (autoimmune) associated with dry eyes, mouth and mucus membranes
- Xerostomia: Many causes: drugs (diuretics, anticholinergics), Sjogren’s, salivary gland disorders, dehydration, mouth breathing. (contributes to tooth decay)
What can cause a toothache?
Caries, periodontitis, wisdom tooth eruption, teething, sunusitis
List some serious concomitant symptoms that can come with toothaches:
HA, fever, swelling, tenderness in floor of mouth, cranial nerve abnormalities
Apical Abscess
development of infx deep into root
- toothache
- more severe pain
- may visualize swelling of mucosa over involved tooth
- urgent dental referral
Ludwig’s Angina:
UNF
Cavernous sinus thrombosis
UNF
If someone has difficulty moving the tongue, it could indicate:
Most often caused by nerve damage, nerve root disorder, cancer
-also could be caused by ankyloglossia (short frenulum)
Results in speech difficulties, moving food when chewing, swallowing
