Oral Cavitiy And Salivary Gland Disorders

Question 1

What is the most common cause of tooth loss in people younger than 35?

Answer 1

Caries/cavities

- primary cause of formation is acid end products of sugar fermentation

Question 2

Aphthous ulcers (canker sores)

Answer 2

Most common superficial mucosal ulcerations
- 40% of the population

Are most frequent in the 1st 2 decades of life and are both painful and often reoccur
- most cases spontaneously in 7-10 days

Cause is unknown, but there seems to be an association with

• celiac disease
• IBD
• Behcet disease

Question 3

HSV infections of the oral cavity in children

Answer 3

Self-limiting primary infection of either HSV-1 or HSV-2

• most are HSV-1
• are reactivated often in times of compromised host immune system
• most arise between 2-4 yrs of age

10-20% of cases can manifest as acute hepatic gingivostomatitis (abrupt onset of vesicles and ulcerations throughout oral cavity during flair up)

Question 4

recurrent herpetic stomatitis

“cold sores”

Answer 4

Are adult HSV-1 lesions that’s re asymptomatic and are self limiting with 7-10 days
- in immunocompromised individuals, can persist instead of being self-limiting

Factors associated with deactivation:

• exposure to UV lights
• extreme temps
• trauma
• allergies
• pregnancy/men’s traction
• upper respiratory tract infections
• immunosupression

*lesions appear at the site of primary inoculation along the mucosa of the infected ganglia (dermatome) *

Question 5

Oral candidiasis (thrush)

Answer 5

Most common fungal infection of the oral cavity
- Candida albicans is the agent

Forms a pseudo-membrane
Of gray/white color that can be scraped off to reveal inflamed red tongue

Predisposing factors:

• immunosupression (#1)
• use of broad spectrum antibiotics

Question 6

Fibromas

Answer 6

Submucosal nodular fibrous tissue masses that are formed in the presence of chronic irritation that results in CT hyperplasia

Most common site = buccal mucosa along the bite line

Treatment = surgical excision

Question 7

Pyogenic granuloma

Answer 7

Inflammatory lesion typically found on the gingiva of children, young adults and pregnant women

• can be nicknamed “pregnancy tumor”*
• also can grow rapidly and mimic malignant neoplasms (they are not though)

Lesions are usually richly vascular and typically ulcerated with red/purple blood

Treatment = complete surgical excision

Question 8

Leukoplakia vs erythroplakia

Answer 8

Leukoplakia

• “a white patch of plaque that CANT be scraped off and cannot be characterized clinically or pathologically as any other disease”
• seen in 3% of world population and can progress to SCCA (5-25%) (squamous cell carcinoma)
• is a disease of exclusion and is assumed cancerous until proven not

Erythroplakia

• “red, velvety sometimes eroded lesion that is flat or slightly depressed relative to surrounding mucosa”
• typically seen in males between 40-70 yrs old
• very high risk of malignant transformation (50%)

both are linked to tobacco use

Question 9

Squamous cell carcinoma in the oral cavity

Answer 9

95% of cancers in the oral cavity

• very aggressive and is found more commonly in males
• develops from dysplastic precursor lesions

Overall survival rates = <50%

• also has high rates of developing new cancers (35%)*
• often shows “field cancerization” which shows multiple different tumors in the same area

Question 10

What are the two pathways of developing SCC in the oropharynx

Answer 10

1) exposure to carcinogens
- smoking is #1 chronic alcohol #2
- frequent mutations involve TP53 and RAS

2) infections, especially HPV
- almost exclusively are seen in the tonsillar crypts or base of tongue
- HPV-16 is #1 subtype
- prognosis is better if they patient is this route rather than #1

Question 11

What are the most common areas of SCC in the oral cavity

Answer 11

Floor of mouth

Lower lip

Soft palate

Gingiva

appear raised,firm pearly plaques as irregular roughened mucosal thickening

Question 12

Morphology of SCC

Answer 12

Can be well differentiated neoplasms to anapalstic aggressive tumors

Most common site of metastasis is cervical lymph nodes, lungs, liver

Question 13

Xerostomia

Answer 13

Dry mouth due to a decrease of production in saliva or increase clearance of saliva

Key factors:

• older than 70 yrs
• current sjogren syndrome
• radiation therapy
• anti-cholinergic side effects of medications

increases rates of dental caries and candidiasis as well as dysphagia

Question 14

Sialadentitis

Answer 14

Inflammation of the salivary glands
- induced by trauma, viral/bacterial infection or autoimmune disease

most common form of viral = mumps

• most common inflammatory lesion = mucocele*
• blockage or rupture of salivary gland ducts

most common form of bacterial = staph. Aureus/ strep. Viridans

Question 15

What is sialolithiasis

Answer 15

Salivary duct obstruction by stones/food debris or edema form injury

Question 16

Pathogenesis of sjogren syndrome

Answer 16

Associated with HLA alleles and activation of autoreactive T-cells/B-cells

Targets the lacrimal and salivary primarily but can also hit exocrine glans in the GI/respiratory tracts and vagina

Question 17

Sjogren syndrome histology

Answer 17

Earliest finding: periductal/perivascular lymphocytic infiltration

Later findings: atrophy acini, fibrosis, hyalinization and fat replacement

Question 18

What is the most common type of cancer associated with sjogren syndrome?

Answer 18

B-cell lymphomas

Question 19

Salivary gland neoplasms

Answer 19

Generally uncommon

65-80% of them arise within the parotid glans
- 10% = submandibular gland

15-30% of parotid gland cancers are malignant
40% of submandibular are malignant
70-90% of sublingual are malignant

the likelihood that a salivary gland tumor is malignant is inversely proportional to the size of the gland

Question 20

Pleomorphic adenoma

Answer 20

Benign tumors that consist of epithelial and myoepithelial cells
- exhibit both epithelial and mesenchymal differentiation (mixed tumor)

60% of tumors in the parotid are pleomorphic adenoma

Characteristics:

• slow growing
• painless
• mobile discrete masses

Most aggressive malignant neoplasms of salivary glands

Treatment = complete excision (if not will regrow)

Question 21

Mucoepidermoid carcinoma

Answer 21

Composed of variable mixtures of squamous cells, mucus secreting cells and intermediate cells

Represent 15% of all salivary gland tumors and occur mainly in the parotid glands

overall is the most common form of primary malignant tumor of the salivary glands

Clinical course and survival rates depend on the histology grade

• low-grade = 90% survival rates w/ 15% recurrence rates
• high-grade = 50% survival rates w/ 30% recurrence rates

Question 22

Warthin tumor

Answer 22

A curious benign neoplasm that exclusively seen in the parotid gland

Occurs more often in males between 50-70
- *high incidence in smokers (8x)

Are benign and have a recurrence rates of 2% after resection (almost always cures)

Question 23

Adenoid cystic carcinoma

Answer 23

A relatively uncommon tumor found in minor salivary glands

Are slow growing and unpredictable tumors
- have a strong tendency to invade perineural spaces and have the highest rates of recurrence

50% become metastatic and move to bone/liver/brain
- survival rates are 5yrs:60/70% ; 10yrs:30% ; 15yrs:15%