week 2-teeth Flashcards
what can poor oral hygine lead to?
GI, cardiovascular, respiratory and immune problems
what is halitosis?
breath odar
what does faintly sulferous breath indicate?
liver failure
what does sweet breath indicate
diabetic ketoacidosis
what does ammonia breath indicate?
renal failure
what is fetor oris?
bad breath originating in the mouth that may be associated with appendicitis
what is xerostomia
dryness of the mouth
what can cause xerostomia?
mouth breathing, dehydration, diuretics, salivary disease, sialoliths
what can a dark line on gingiva indicate?
heavy metal poisoning.
Bruxism?
clenching and grinding of teeth
what should we look for on teeth?
wearing down, cracks, loss or decay
petechiae
broken capillary blood vessels
what should we look at tongue for?
oral cancers, tongue movements, enlargement, papillae
What are the 6 diagnoses that are possible on the lips?
Recurrent herpes labialis, carcinoma, mucocele, chelitis and angular chelitis
what causes herpes labialis?
HSV 1
characteristics of herpes labialis?
Prodrome itch or burn 12-36 hours, cluster of vesicles, rupture, crusting
what is a trigger for reccurent herpes labialis
UV light, stress, trama, menstruation,
what is a concern for those with herpes labialis?
auto inocculation to skin or eyes
what type of cancer is ususally of the lip?
squamous cell carcinoma
does squamous cell carcinoma spread?
High risk of metastasis
what does SCC lip lesion look like?
painless, sharp edges, doesnt heal, grows slow, can bleed
what is DDx for SCC of the lip?
may look like a plaque or verrucous
how would SCC be diagnosed?
biopsy
what is a mucocele?
soft cyst, mucin filled cavity with mucus glands lining cavity,
where is a mucoele most common
lip, and under tongue
what is the cause of a mucoele?
minor injury to ductal system of labial or sublingual salivary gland
main features, of mucoele?
clear or bluish bubble, movable, 1-2cm, it can burst and reappear
what is chelitis?
chapped lips
what could cause chapped lips?
wind burn, allergies, lip licking and retinoids
danger of chapped lips?
may become infected
what is angular chilitis?
deep cracks at labial commissure , spits, bleedin and shallow ulcers possible.
what could cause angular chilitis?
ill fitting dentures, bite change, poor oral hygine, dry mouth, Deficiency of B2, B12 and iron def anemia
what lab would be used to confirm angular chelitis?
KOH to rule out candida
what is plummer vinson syndrome
syndrom with chelitis, iron def anemia and upper esophagus web
what are the 16 mouth diagnosis?
oral lichen planus, leukoplakia, erythoplakia, oral SCC, Melanoma, fordyce spots, stomatitis, oral candidiasis, pseudomembranous stomatitis, recurrent apthous stomatitis, minor-major form apthous ulcers, herpetiform ulces, heretic gingivostomatis, oral erythema multiforme, chancer
oral lichen planus looks like what?
non erosive, lace like white papule or streak, like white marbling
where is oral lichen planus mostly?
buccal to gingival margin, so inner cheek mostly
what should you try to help confirm oral lichen planus?
try to wipe it off, it should not wipe off.
What is leukoplakia?
white patches or plaques that cannot be wiped off
where can leukoplakia be found?
all over the mouth.
why would we biopsy to confirm leukoplakia?
to make sure it isn’t SCC, verrucous carcinoma etc.
if something looks like leukoplakia but wipes off, what could it be?
candidiasis or an asprin burn
Characteristics of leukoplakia patches?
white, grey or yellowish, flaking paint so sort of thick., may be rough if palpable
what can cause leukoplakia
trauma, dentures, tobacco, alcohol, syphilis, vit deff, endocrine, AIDs
erythroplakia is what
red macule or plaque with a soft texture and and demarcated edge
what is concerning about leukoplakia
precancerous hyperplasia of squamous epi, may turn to cancer slowly
what is concerning about erythroplakia?
precancerous cancer in 40%of cases
what causes erythroplakia?
unknown but its from epithelial displasis
Oral squamous cell carcinoma looks like what?
has red border, may look like leukoplakia or erythroplakia, and be ulcerated.
what could be the first indication of oral SCC?
mass in neck.
who gets oral SCC
smokers, alcoholics and HPV 16
why is it importaint to biopsy any persisten papules, plaques, erosions or ulcers?
SCC
Melanoma looks like what
pigmented lesions, assymetric, irregular border, variable color, diameter increasing, and E
DDX for melanoma is what?
oral melontic maccules
what happens if you press on a melanoma?
it doesn’t blanch
what are fordyces spots?
benign neoplasm from sebaceous gland, they look like little grains
what do fordyce spots look like?
white to yellow tiny 1-2mm papules that are in a cluster, thinning as they move away.
when are fordyce spots more common
20-30yo
what is a stomatitis?
inflammation of oral tissues from local or systematic conditions.
what def could cause stomatitis?
vit B, vit C, iron.
what is oral candidiasis also called
thrush
what is oral candidiasis and what is it caused by?
oral fungal infection by candida albicans, glabrata or tropicalis.
what does oral candidiasis look like
slightly raised soft white plaque that may have burning sensation associated with it.
how could you make sure that oral candidiasis wasn’t leukoplakia?
oral candidiasis wipes away altough it may cause a bit of bleeding.
how could you confirm oral candidiasis?
KOH prep
what would recurrent persistent oral candidiasis warrant?
immune status evaluation
what is pseudomebranous stomatitis?
inflammatory reaction, produces a membrane like exudate
what are some symptoms that go along with pseudomembrane stomatous
can be localized but may have feaver, malaise also
what would cause pseudomembranous stomatitis?
chemical irritants or bacterial infections.
what is a recurrent apthosus stomatitis?
acute necrotizing ulcerations or oral mucosa - cancre sore,
description of apthosus stomatitis
painful, round/oval, grey shallow ulcers with red boarder on movable mucosa
can apthosus stomatitis have a prodrome
yep, burning or tingling
what may cause apthosus stomatitis?
trama, tooth brush, bite, allergies to food or chemicals, stress, celiac IBS
what def could cause apthosis stomatitis?
Vitamin B12, Iron, and Folic acid. This is slightly different from stomatitis in general
what could possible mediate apthosis stomatitis?
T-cell mediated is possible
what are the three types of apthous ulcers?
herpetiform ulcers, minor form aphthous and major form aphthosus.
what type of aphthous ulcers are more common in childhood
minor form aphthous ulcers
what type of aphthous ulcers are more common after puberty
major form aphthous ulcers.
how long do mino aththous ulcers last
up to 7-10 days without scarring
how long to major apthosis ulcers last?
up to 6 weeks with scarring
size of minor aphthous ulcers
less than 1 cm and are oval
size of major aphthouss ulcers
up to 2 cm with ragged edges
color of minor for aphthous ulcers
yellow grey wit yellow raised border with red halo.
what is the most severe form of mouth ulcers?
herpetiform ulcers
what form of apthous ulcers are more common in females with adult onset
herpetiform ulcers
what do herpetiform ulcers look like
multiple pinpoint lesions under 3mm each in clusters that combine into ulcers.
how long do herpetifor ulcers last?
less than 1 month
which of the aphthous ulcers are singular
minor aphthous ulcers
DDx for herpetiform ulcers 5?
trauma, pemphigus vulgaris, cictrical pemphigoid, crohns, sprue
what is herpetic gingivostomatitis
cold sore also caused by HSV-1
does herpetic gingivostommatitis have prodromal symptoms?
yes, pain burning, feaver, maliase
what do herpetic gingivostomatitus lesions look like
eruption of vesicular lesions with an erythematous base that crusts
what mouth surface are gingivostomatitus lessions located on?
unmoveable oral mucosa
how long do oral cold sores last
1-2 weeks, maybe with fever
how are oral cold sores, herpetic gingivostomatitus diagnosed
Tzank smear, immunofloroesence, viral culture.
what could herpetic gingiovostomatitus DDX
apthous stomatitis, erythmatous multiforme, drug eruptions, pemphigus
Oral erythema multiforma is what
hypersensitivity reaction to HSV, organisms , drugs or idiopathic
what does erythema multiforma look like?
painfull stomatitus, sudden hemorrhagic vesicles with bullae and red base that burst leaving painful crusting.
does erythema multiforma have prodrome
sinusitis and rhinitis
other symptoms with erythema multiforma
high fever 4-5 days, severe systemic symptoms, and target lesions on rest of body
what could erythema multiforma DDX
apthous stomatitis, allergic stomatitis, pemphigus, herpes.
how could you tell that erythema multiforma isnt herpes?
I would look for the target lesions to confirm EM, and herpies is either on vermilian border ofouter lips or immovable mucosa , EM is on lips or any mucosa
how would you differentiate between erythema multiforma and apthous stomatitis?
aphthous stomatis all versions have ulcers without crusting
what is a Chancre
single ulcerated lesion formed during primary stages of syphillis
characteristics of Chancre
painless, single, no central necrotic tissue
how can we tell that a chancre isn’t a aphthous stomatitis of some sort?
chancre doesn’t have necrotic tissue in the center
what is the bacteria that causes canchre, syphillis
treponema pallidum
where can chancre be found
lips tongue or genitals, so if you find one, check genitals also
how can syphillis be diagnosed?
PCR
what are 5 more mouth irritation inflammation diagnoses
Frictional hyperkeratosis, epulis fissura, denture sore spot, irritation fibroma
what causes frictional hyperkeratosis
chronic friction from biting or dentures
what does frictional hyperkeratosis look like?
white, hyperkeratotic lesions, may be white like where teeth meet. Can look like leukoplakia
what should you do if unsure if its frictional hyperkeratosis
biopsy and concider it idiopathic leukoplakia
epulis fissura is what?
denture caused hyperplasia,
what does epulis fissurea look like
painless folds of tissure with denture edge impression, can be red or ulcerated.
what is texture of epulis fissurea?
firm or spongy
what does denture sore spot look like
ulcers, painful, overlying grayish necrotic membrane surrounded by red halo.
denture sore mouth?
exreamly red mucosa, under dentures, sharp demarkation, burning senstioan
what probably causes denture sore mouth
allergy to acrylic or denture glue, fungal infection
irritation fibroma is what
Painless swelling less than 1cm that is lighter than rest of mucosa on buccal, lat tongue or lower lip.
when is irritation fibroma most common?
20-49yo
what is the texture of irritation fibroma?
firm resilient or soft and spongy.
how is irritation fibroma DDx?
location - tongue, neurofibroma, granular cell tumor, lower lip buccal, lipoma, mucocele or salavary gland tumor
how would you determin its irritation fibroma not mucocele?
color of mucocele is clear or bluish and its 1-2cm so its larger
how would you determin its irritation fibroma not a lioma
color of lipoma is yellowish and made of fat, irritation fibroma is just swelling
what are 7 other mouth edema and other things
angioedema, hereditary angioedema, palatal/mandibular torus, hemangioma, varicosities, papilloma, lipoma,
what is angioedema
acute swelling of skin, mucosa and submucosa with rapid onset.
signs and sx of angioedema
painless, non puritis, non pitting, well circumscribed rapid onsed. , there may be itchy rash Edema.
what causes angioedema?
Allergic response, but not IgE, food, medication, stress, infection and autoimmuned disorders
why is angioedema a concern?
it may obstruct airway causing death
Hereditary angioedema
edema that is rare, autosomal dominant of face, airway hands and feet without an itch.
what can accopany a hereditary angioedema attack?
abdominal pain, vimiting, diarrhea and NON itchy rash
what is palatal or mandibular torus?
nodular bone protuberence, slow growing on upper or lower palate
who is most likely to get torus?
women before age 30
Hemangloma is what
proliferation of blood vessesl.
what does hemangloma look like?
flat or raised but deep red or bluish red, similar to blood blister
what is DDX for hemangloma
artervenous fistula if histry of trauma
concern for hemangloma
infection if its in a spot that causes biting.
varicosities are what
dilated tortuous veins in oral cavity, varicose veins.
what would cause mouth varicosities
increased hydrostatic pressure and poor tissue support
Papilloma is caused by what
HPV
what does papilloma look like
wart less than 1 cm, well circumscribed, pedunculated benign growth.
DDX for papilloma
verruciform xanthomas
lipoma is what?
painless benign slow growing mass of adipos tissue on cheek or tongue
what does lipoma look like
yellowish, tis rubbery and mobile
what are the 4 conditions of the salivary glands?
sialadenitis, sialolisthesis, sjogrens syndrome, xerostomia
what is sialadenitis
benign swelling seen in many systemic diseases ,infections etc.may or may not be painful
example that wiould have sialadenitis?
mumps,
what is sialolisthesis
salivary duct stones causing swelling associated with eating
what is sjogrens syndrome
systemic inflammation that is associated with dry eyes, mouth and mucus membranes
what can cause Xerostomia
drugs, diruetics sjogrens, dehydration mouth breating
why is xerostoma concerning
contributes to tooth decay
what are 6 concerns for teeth and gums?
gingivitis, vincents angina, periodontitis, caries, toothache , tooth loss,
what is gingivitis?
inflammation of gums with redness pocket formation,
signs and symptoms of gingivitis
bright red and swolen, receding gums, painless unless pressure, easily bleed.
prevention of gingivitis
good oral hygine,
what can cause gingivitis?
poor oral hygine, food impaction, mouth breething, drugs, phenytoin, and nifedipine
what two drugs are known to cause gingival hypertrophy
dilantin, phenytoin, and nifedipine
what is vencents angina
trench mouth, acute infection of gingiva
what causes vincints angina?
fusiform bacteria and spirochetes, poor hygine, stress, malnutrition
where is vincents angina most common
smokers, alcholicis and HIV
signs and symptoms of vincents angina
progressive, painfull infection with ulceration, swelling and sloughing off of dead tissues, effecting all gum tissue, bad odar. Punched out
what is peridontitis
infection of peridontium, inflammation of peridontal lig. Gingival cememtum and alveolar bone
what causees peridontitis, etiology.
progressive gingivitis, that allows for growth of anerobic bacteria in pockets that leads to bone loss.
risks of peridontis
poor hygine, diabetes II, leukemia, Chrons disease
signs and symptoms of peridontis
no pain unless acute, food impaction, tooth tender to percussion, visible plaque, red swollen gums with exudate.
what causes dental caries
bacteria in plaque release acids that erode enamel.
why do meth users lose their teeth
xerostoma, bruxism, poor nutrition and hygine.
symptoms of carries
pain with hot, cold , sweet or beverages.
what are serious concomitant symptoms with toothache?
headache, fever, swelling, tenderness at floor of mouth, CN abnormalities.
what can cause tooth ache
caries, peridontitis, wisdom teeth, teething, sinusitis
what should our response to apical absess be?
urgent dental referral
response to ludwigs Angina?
emergency room
Resonse to cavernous sinus thrombosis?
emergency room
what would an apical tooth absess look like?
infection of deep root, severe pain with possible swelling of mucosa over tooth.
what is ludwigs angina
cellulitis (skin infection)of mouth floor from infection
SSX of ludwigs angina
swelling, maliase, fever, dysphagia, stridor
SSX or cavernouus sinus thrombosis
headache, vision change, paralysis of cranial nerves.
what can cause cavernous sinus thrombosis
staph or strep infection that can clead to blood clot in cavernous sinus
why would adults lose teeth
trauma, decay, gum disease, meth
what are some problems with the tongue
difficulty moving, deviation, taste abnormalities, color changes, pain, hair, tremor, furrows, dry. Smooth, enlarged
what would cause deviation of tongue
CN XII, hypoglossal parylasis
what would cause tast abnormalities
facial or glossopharyngeal CN damage, medication side effect, trauma,
what def can cause taste abnormalities
B3, Zn deficiency
what conditons can cause taste abnormalitys
bells palsy, MS.
what is a geographic tongue?
localized area loss of filiform palille, leaving red patches with white or yellow borders.
DXX for geographic tongue?
leukoplakia, candidiasis, psorisis, lichen planus
white or yellow tongue from what
local irritation
what def can cause a red tongue
folic acid and B12
what conditions can cause a red tongue
celiac, scarlet fever, pellagra.
Hyperpigmentation of tongue
drugs, addisons disease
what causes a hairy tongue?
hyperplasia of filiform pa;illae.
what may cause hairy tongue?
oxidizing mouth wash, poor oral hygine, AIDs, drugs, tobacco
what can cause tongue pain
trauma, smoking, neuropathy, cancer, ulcers, leukoplakia, menopause burning tongue, dentures, refered pain from heart
Why can tongue tremor be a concern?
neurological disease of lower motor neurons, brain stem lesions or hypoglossal neuropathy.
what can a fine tongue tremor indicated
hyperthyroidism
what can a course tremor indicate
nervousness
what furrows in tongue are congenital
deep transverse
what should you concider with deep midline tongue furrows
dehydration of syphilis
dry tongue with furrows
dehydration
dry tongue without furrows think what
sjogrens
what does atrophic glossitis look like
atrophy of filiform papillae small, smooth glossy tongue that may be red and painful.
what could cause atrophy of filiform papillae
Low HCL, B12, folic acid, iron and proteind def., celiacs
What could cause enlarged tongue
allergic reactions, leukemia, downs, pellagra, strep
Glossitis is what
acute or chronic inflammation of tongue
what may indicacate pernicious anemia
inflammed tongue that is pale.
firey red tongue may indicate what?
B vit def.
throat conditions
acute pharyngitis, viral pharyngitis, bacterial pharyngitis, diptheria, tonsilitis, peritonsilar absess, arapharyngeal absess, retropharyngeal abscess, pharnyx infection, velopharyngeal insufficency, malignancies in pharynx
what type of pharyngitis is very common
viral, 90 percent of the time
what are two comon viral infectons that cause pharyngitis
adenovirus and epstin barr virus, mono)
adenovirus pharyngitis
throat is NOT red,no fever, painful, runny nose, modest node enlargment, 24-48 hour to get sore
Infectious mono
No fever, exudative tonsilitis, kissing tonsils, signifigant node swelling, splenomegaly, fatigue, weight loss,
what labs to detect mono?
CBC that show abnormal lymphocytes, and monospot
what is different between bacterial and viral pharygitis
bacterial onset is faster, fever, redder throat, and larger nodes
what is intersting about viral pharyngitis throat?
cobbelstoning
what does bacterial pharyngitis look like
beefy red, unilateral swelling, quick onset, high temp, headache,
what causes most bacterial pharyngitis?
Group A streptococus
what questions to determine GAS for bacterial pharyngitis?
Modified center criteria, absence of cough, tenter ant cervical, exudate gram stain culture.
what does rapid strep test do?
positive rules in strep, a negative doesn not rule out strep.
what is modified center criteria good for
terrible at ruling in, but good at ruling out strep.
what is dipthera caused by
corneybacterium mostly in other countries.
what does diptheria look like?
dirty grey speudomembrain, dyspenea, low fever, nausea and vomiting.
how is diptheria diagnosed?
gram stain.
what is complication of diptheria
myocarditis, NS toxicity
what is tonsilitis
acute inflammation of palatine tonsils
SSX of tonsilitis
sudden onset, hight fever, malise, vomiting, bad breath, enlarged tonsil, exudate
what causes tonsilitis
Bacterial, group A strep, viral, EBV , adenovirus
what are complications of tonsilitis?
peritonsilar absess, tonsillotolithis, hypertrophy of tonsils
what is peritonsilar absess?
absess between tonsil and pharyngeal constrictor muscle.
complications of strep
Pandas pediatric autoimmune neuropsychiatric disorder associated with strep, Rheumatic fever, toxic shock, glomerulonephritis
signs of peritonsilar absess?
worsening unilateral sorness that can be seen from INSIDE, fever, headache, high fever, limit mouth opeing
what is parapharyngeal absess
absess lateral to superior constrictor muscle and close to corodid
sign of parapharyngeal absess?
seen from OUTSIDE, swolen anterior triangle ofneck
what should we do if we see parapharyngeal absess
I don’t know, its super serious, refer?
what should we do if we see a retropharyngeal abscess
refer to ER, medical emergency, including airway complcations.
whhat is retropharyngeal abscess
infection of deep space in neck., infection spreads from nose ,ears, sinus etc.
SSX or retropharyngeal abscess
pain, sore throat, pain on swallowing, jaw stiffness, lump in throat, chills, fever,
chronic irritatio nof pharynx causes what
cobbelstoning
what is velopharyngeal insufficiency?
incomplete closure of sphincter between oro an nasal pharyns, inpaired speech andeating.
what is the most common malignancy in the pharynx?
SCC
what does pharynx malignancy look like
mass in neck, pain by abnormal throat sticking, tumor is red smooth and can look similar to erythoplakia
what is hoarsness
structural changes to vocal cords that impair ability to vibrate.
why would child be horse
vocal abuse
laryngitis is what
hoarse voice or loss of voice because of vocal cord irritation.
what can cause laryngitis
infection, inflammation, coughing
what to do with epiglottitis
medical emergency, don?t examine
what is SSX of epiglottitis
fever, difficulty swallowing ,drooling, appers very ill and anxious.
who does epiglottitis mostly effect
2-5 yo
DXX for epiglottitis
group, peritonsilar abscess, retropharyngeal absess.
how would you know it was eppiglottitis not peritonsilar absess?
peritonsilar is after tonsilitis, rare in infants, droolin in eppi
how would you know it was epiglottitis not retropharangeal absess?
sore thhroat, jaw stiffness, for retropharangeal, still super serious!
vocal cord polyp
horseness, vocal abuse, allergies, irritants diagnosed by visualization and biopsy
what causes vocal cord contact ulcers
gastric reflux
what is the most common cancer in head and neck?
layrngeal scc
Lump in necks in kids?
tonsilitis, TB, brachial cysts
lump in adult necks
inflamatory or neoplastic nodules.
