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_Patient Care II > 1/29: Intraoral Exam II > Flashcards

1/29: Intraoral Exam II Flashcards

1
Q

What is xerostomia a side effect of?

A

Numerous over the counter and prescription medications

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2
Q

What can xerostomia be a symptom or sign of?

A

Systemic disorder or disease

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3
Q

What can xerostomia be a response to?

A

Physical climate, or a manifestation of an emotional response

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4
Q

Who is at a greater risk for developing a dry mouth condition?

A

Elderly patients, but the problem is not limited to any specific age group

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5
Q

What does xerostomia increase your risk for?

A

Caries, erosion, dentinal hypersenstivity, and candidiasis

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6
Q

Most cases of xerostomia are _______

A

Chronic

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7
Q

What are med history of xerostomia?

A
  • diabetes
  • hormone changes (menopause, pregnancy)
  • depression, anxiety medications
  • radiation for head and neck cancer
  • autoimmune disorder (Sjogren’s syndrome)
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8
Q

What is a subjective evaluation of xerostomia?

A
  • Do you have difficulty swallowing?
  • Does your mouth feel dry when eating?
  • Do you sip liquids to help swallowing?
  • Do you have any oral burning or soreness?
  • Do you often have bad breath?
  • Do you eat crushed ice or drink fluids to keep your mouth moist?
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9
Q

What is a clinical assessment of xerostomia?

A
  • Reddened, pebbled surface of tongue
  • dry and cracked corners of the mouth
  • red, glossy, parched mucosal tissues
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10
Q

What is the test for xerostomia?

A
  1. Mirror “stick” test: place mirror against the buccal mucosa and tongue
  2. Saliva pooling: check for saliva collection in the floor of the mouth
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11
Q

What should you evaluate in a patient with xerostomia?

A

Flow and consistency
- tissues well moistened?
- sore mucosa
- burning sensation in the mouth

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12
Q

What are xerostomia symptoms?

A
  • candidiasis
  • angular chelitis
  • burning tongue
  • root and cerivcal caries
  • stomatitis
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13
Q

What is stomatitis?

A

Inflammation of the mucous membranes of the mouth

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14
Q

What is candidiasis?

A
  • white plaque
  • creamy white lesions
  • looks like hyperkeratosis (BUT RUBS OFF)
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15
Q

Where is candidiasis located?

A

Buccal mucosa
Lateral borders of the tongue

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16
Q

What is another name for candidiasis?

A

Thrush

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17
Q

Where can candidiasis spread to?

A

Tongue
Hard and soft palate
Tonsillar region

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18
Q

What are candidiasis risk factors?

A

Immunocompromised
Pregnancy
Poor oral hygiene
Smoking
Stress
Depression

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19
Q

What are candidiasis risk factors?

A

Birth control pills
Long term AB
Diabetes
Dentures that don’t fit
Xerostomia
Iton, B12 deficiency

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20
Q

What is Acute Pseudomembranous?

A

MOST COMMON TYPE OF CANDIDIDIS
Creamy white patches
Easily wipe off leaving an erythematous base

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21
Q

What do you get pain with in Acute Pseudomembranous?

A

Spicy/acidic foods
Dysphagia

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22
Q

Where is Acute Pseudomembranous located?

A

Tongue, buccal mucosa, floor

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23
Q

What does Acute Pseudomembranous look like?

A

White plaque
Hyperkeratosis (but rubs off)

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24
Q

Where is Acute Pseudomembranous located?

A

Inside the corners, buccal mucosa, lateral tongue

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25
Q

What is the relation between atrophic candidiasis and dentures?

A

It can be located under dentures, usually ill-fitting or dentures are never taken out of mouth

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26
Q

What does atrophic candidiasis look like?

A

Red on palate or tongue

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27
Q

What does atrophic candidiasis burn due to?

A

With spicy foods and alcohol

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28
Q

What is treatment of candidiasis?

A

Oral hygiene
Yogurt, acidophilus
Avoid alcohol, simple sugars

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29
Q

What is the most common candidiasis?

A

Acute Pseudomembranous

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30
Q

What are medications that treat candidiasis?

A

Antifungals
- nystatin (rinse and tablets)
- ketaconozole (can cause severe liver damage)

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31
Q

What kind of herpes is seen mainly in children?

A

Primary herpes gingivostomatitis

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32
Q

What is primary herpes gingivostomatitis caused by?

A

HSV1 in most cases

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33
Q

Severe primary infections of herpes simplex have?

A

Oral lesions accompanied by high fever, malaise, cervical lymphadenopathy and dehydration

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34
Q

In less comon-primary infection of herpes what is this due to?

A

HSV1 or HSV2

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35
Q

What is herpes gingivostomatitis?

A

Vesicles develop in the oral cavity, including the pharynx, palate, buccal mucosa, lips and/or tongue

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36
Q

What do vesicles break down into in herpes gingivostomatitis?

A

Small ulcers and are covered with an exudate

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37
Q

Where do lesions extend into in herpes gingivostomatitis?

A

Lips and buccal mucosa

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38
Q

When do lesions resolve without therapy in herpes gingivostomatitis?

A

Without therapy in two weeks

39
Q

Where does HSV not survive long in?

A

External environment

40
Q

Almost all primary infections of herpes gingivostomatitis occur from contact with?

A

An infected person who is releasing the virus

41
Q

What ages does herpes gingivostomatitis start?

A

<10 from adults

42
Q

What is herpes gingivostomatitis caused by?

A

Contagious
Kissing, etc

43
Q

What are the two types of herpes gingivostomatitis?

A

type 1 = mouth, lips, face
type 2 = genital

44
Q

Where is the location of herpes gingivostomatitis?

A

Outer lips and attached gingiva

45
Q

What are two common things that manifest as herpes simplex?

A

Fever blisters and cold sores

46
Q

What are prodromal signs of herpes simplex?

A
  • Tingling, itching, pain, burning that arise 6-24 hours before lesions develop
  • Multiple fluid-filled blisters
  • Merge and collapse
  • Yellowish crust
  • 2 weeks healing
47
Q

What is herpes simplex considered?

A

Virus

48
Q

Where is herpes simplex dormant?

A

In nerve cells

49
Q

When does herpes recur?

A

With immune weakness
- stress
- fever
- illness
- injury
- sunburn

50
Q

What is herpetic whitlow?

A

Infections of the thumbs or fingers
Grouped, fluid or pus filled
Usually itch and or painful

51
Q

In the past, how was primary herpetic gingivostomatitis treated?

A

Symptomatically, but if the infection is diagnosed early, antiviral medications can have a significant influence

52
Q

What is medication as treatment for herpetic gingivostomatitis?

A

Acyclovir suspension-initiated during the first 3 symptomatic days in a rinse and swallow technique 5x/day for 5 days
Significant acceleration in clinical resolution is seen
Development of new lesions ceases

53
Q

In which phase is recurrent herpes labialis best treated?

A

Prodrome phase

54
Q

What kind of ointment/cream decreases the number of vesicles in herpes labialis?

A

Acyclovir, but clinically minimal reduction in healing and pain

55
Q

What are 3 medications for herpes labialis?

A

Systemic acyclovir
Valacyclovir
Famciclovir

56
Q

For patients whos herpes labialis recurrences appear associated with dental procedures, what is their regiment?

A

2g of valacyclovir taken 2x on the day of procedure and 1g taken 2x the following day

57
Q

What happens to patients that are on medication for herpes labialis but are immunocompromised?

A

The viral load tends to be high, and replication is not suppressed completely by antiviral therapy

58
Q

What are aphthous ulcer also known as?

A

Canker sores

59
Q

What age do aphthous ulcers (canker sores) start and what is their prevalence and frequency?

A

60% of the US pop
10-20 years old
Frequency varies

60
Q

When does prodromal tingling or burning sesnation begin in aphthous ulcers (canker sores)?

A

1-2 days before the ulcer appears

61
Q

What is the duration of aphthous ulcers (canker sores)?

A

3 days pain, 7 days healed

62
Q

What is treatment if aphthous ulcers (canker sores) is mild?

A

Topical corticosteroids

63
Q

Although no single triggering agent is responsible, the mucosal destruction of aphthous lesions represents?

A

A t-cell mediated immunologic reaction

64
Q

Aphthous lesions tends to occur along?

A

Family lines. When both parents have a history of aphthous ulcers, there is a 90% chance that their children will develop the lesions

65
Q

What are the three clinical variations of aphthous lesions?

A

Minor
Major
Herpetiform

66
Q

Patients experience fewest recurrences and shortest duration in what?

A

Minor aphthous ulcerations

67
Q

Where do Minor aphthous ulcerations arise?

A

Almost exclusively on nonkeratinized mucosa

68
Q

What are minor aphthous ulcerations preceded by?

A

An erythematous macule in association with prodromal symptoms of burning, itching, or stinging

69
Q

What is the size of minor aphthous ulcerations?

A

Measure between 3-10mm in diameter, oval, and heal without scatting in 7-14 days

70
Q

How many lesions cause out of proportion pain for minor aphthous ulcerations?

A

1-5 lesions for the size of ulceration

71
Q

What mucosa is most frequently affected by minor aphthous ulcerations?

A

Buccal and labial mucosa followed by the ventral surface of the tongue

72
Q

What is recurrence rate of minor aphthous ulcerations?

A

Highly variable, ranging from one ulceration every few years to two episodes per month

73
Q

What is the size of major aphthous ulcerations?

A

Larger than minor aphthae- usually 1-3cm

74
Q

What kind of aphthous ulcerations have the longest duration per episode?

A

major aphthous ulcerations

75
Q

What are the size of major aphthous ulcerations?

A

Deeper and can take 2-6 weeks to heal

76
Q

What can major aphthous ulcerations lesions cause?

A

Scarring

77
Q

When is the onset of major aphthous ulcerations?

A

After puberty

78
Q

What is the greatest number of lesions and most frequent recurrence?

A

Herpetiform aphthous ulcerations

79
Q

What are the size of Herpetiform aphthous ulcerations?

A

Small 1-3mm with as many as 100 ulcers present in a single recurrence

80
Q

What do Herpetiform aphthous ulcerations have resemblence to and why?

A

Because of their small size and large number, the lesions bear a superficial resemblance to a primary HSV infection

81
Q

In Herpetiform aphthous ulcerations, it’s common for individual lesions to ______ into ___________ ulcerations

A

coalesce; larger irregular

82
Q

What is the healing time of Herpetiform aphthous ulcerations?

A

7-10 days, but the recurrences tend to be closely spaced

83
Q

Many patients are affected almost constantly for period as long as _______ due to Herpetiform aphthous ulcerations

A

3 years

84
Q

What mucosa is involved in Herpetiform aphthous ulcerations?

A

Any mucosa

85
Q

What is the gender predominance and onset age of Herpetiform aphthous ulcerations?

A

Female; adulthood

86
Q

What are the size of minor canker sores (aphthous ulcers)?

A

<1 cm and shallow

87
Q

What are the size of major canker sores (aphthous ulcers)?

A

> 1 cm and deeper

88
Q

What kind of minor canker sores (aphthous ulcers) scar when heal?

A

Major aphthous ulcers

89
Q

What kind of canker sores or aphthous ulcers are more numerous and vesicular?

A

Herpetiform

90
Q

What are symptomatic treatments for aphthous ulcers?

A
  1. Viscous benzocaine
  2. Orajel, anbesol
91
Q

What are local anti-inflammatory treatment for aphthous ulcers?

A

Kenalog in orabase paste 2-4x/day

92
Q

What is an example of a sesaling agent as a treatment for aphthous ulcers?

A

Amesal, etc

93
Q

What is the only FDA approved tx for canker sores (aphthous ulcers)?

A

Aphthasol
paste = barrier
apply 2-4x/day
(must start early (prodroamal stage))

_Patient Care II (10 decks)

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