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

Intraoral Exam Part 2 Flashcards by sophie rosen

hairy tongue

trapped debris including 
bacteria
fungus
coffee 
tobacco
antibiotics and other drugs can cause

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Floor of the mouth: visual (4)

Tongue to palate
Lumps, bumps, swellings
Mandibular tori
Submandibular duct

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Submandibular duct is also called

Wharton’s duct

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Wharton’s duct

Drains saliva from the submandibular and sublingual glands

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Wharton’s duct accounts for –% of saliva

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what is found of the ventral surface of the tongue?

lingual varicosities

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lingual varicosities are normal with

age

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Floor of the mouth palpation (4)

Have pt lift tongue up
One finger under one side of tongue
Have pt close down ½ way
One finger of other hand goes under chin

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Floor of the mouth palpation (3)

Gently press two fingers together
“Walk” fingers to posterior
“Walk” external finger farther

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Xerostomia is a side effect of

numerous over-the-counter and prescription medications

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Xerostomia can be a symptom or a sign of a

systemic disorder or disease

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Xerostomia can be a response to —, or a manifestation of —

physical climate

an emotional response

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who is at a greater risk of Xerostomia?

Elderly patients are at greater risk for developing a dry mouth
condition, the problem is not limited to any specific age group

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xerostomia significantly increases the risk of (4)

caries,
erosion,
dentinal hypersensitivity,
and candidiasis

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most cases of xerostomia are

chronic

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Xerostomia: Med History includes (5)

Diabetes
Hormone changes (Menopause, Pregnancy)
Depression, anxiety-medications
Radiation for head & neck cancer
Autoimmune ds.(Sjogren’s syndrome)

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Xerostomia: subjective eval. questions (6)

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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Xerostomia: clinical assessment (3)

Reddened, pebbled surface of tongue
Dry and cracked corners of the mouth
Red, glossy, parched mucosal tissues

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xerostomia test (2)

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

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Evaluate flow & consistency for xerostomia (3)

tissues well moistened?
Sore mucosa
Burning sensation in the mouth

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Xerostomia symptoms (6)

Candidiasis
Angular chelitis
Burning tongue
Root & Cervical caries
Stomatitis
Dysphagia

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Stomatitis-

inflammation of the mucous membranes of the mouth

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what does candidiasis look like? (3)

White plaque
Creamy white lesions
Looks like hyperkeratosis, but rubs off

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where does candidiasis affect? (2)

buccal mucosa

lateral boarders of the tongue

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Candidiasis (“Thrush”) | •Can spread to (3)

* Tongue * Hard and soft palate * Tonsillar region

Candidiasis risk factors (12)

* Immunocompromised * Pregnancy * Poor oral hygiene * Smoking * Stress * Depression * Birth control pills * Long term AB * Diabetes * Dentures that don’t fit * Xerostomia * Iron, B12 deficiency

most common Candidiasis

Acute Pseudomembranous Candidiasis

Acute Pseudomembranous Candidiasis affects the (3)

tongue buccal mucosa floor

Acute Pseudomembranous Candidiasis looks like (2)

creamy white patches | easily wiped off leaving an erythematous base

Acute Pseudomembranous Candidiasis: pain with

spicy, acidic foods

Acute Pseudomembranous Candidiasis: difficulty

swelling (dysphagia)

Acute Pseudomembranous Candidiasis physically looks like (3)

* White plaque * Looks like hyperkeratosis, but rubs off * Inside the corners, buccal mucosa, lateral tongue

Atrophic Candidiasis (3)

* Under dentures- usually ill-fitting or dentures are never taken out of mouth. * Red on palate or tongue * Burn w/ spicy foods & alcohol

Candidiasis treatment (6)

* Oral hygiene * Yogurt, acidophilus * Avoid alcohol, simple sugars * Medications-antifungal * Nystatin * rinse and tablets * Ketaconozole

Ketaconozole –can cause

severe liver damage

PRIMARY HERPES GINGIVOSTOMATITIS IS SEEN MAINLY IN --- AND IS CAUSED BY --- IN MOST CASES

CHILDREN | HS1

HERPES SIMPLEX SEVERE PRIMARY INFECTIONS HAVE ORAL LESIONS ACCOMPANIED BY (4)

HIGH FEVER, MALAISE, CERVICAL LYMPHADENOPATHY AND DEHYDRATION

HERPES SIMPLEX: LESS COMMONLY, PRIMARY INFECTION OCCURS IN THE ---; IN SUCH CASES INFECTIONS MAY BE FROM EITHER (2)

YOUNG ADULT | HSV1 OR HSV2

HERPES GINGIVOSTOMATITIS (2)

VESICLES DEVELOP IN THE ORAL CAVITY, INCLUDING THE PHARYNX, PALATE, BUCCAL MUCOSA, LIPS, AND/OR TONGUE. THE VESICLES RAPIDLY BREAK DOWN INTO SMALL ULCERS AND ARE COVERED WITH AN EXUDATE

HERPES GINGIVOSTOMATITIS LESIONS MAY EXTEND TO INVOLVE THE (2)

LIPS AND BUCCAL MUCOSA

HERPES GINGIVOSTOMATITIS: THE LESIONS GENERALLLY RESOLVE WITHOUT THERAPY IN

TWO WEEKS

HSV-

DOES NOT SURVIVE LONG IN THE EXTERNAL ENVIROMENT & ALMOST ALL PRIMARY INFECTIONS OCCUR FROM CONTACT WITH AN INFECTED PERSON WHO IS RELEASING THE VIRUS.

Herpes Simplex-fever blisters, cold sores: | affects

50% of the population

Herpes Simplex-fever blisters, cold sores: | age

starts <10, from adults

Herpes Simplex-fever blisters, cold sores: is ...

contagious (kissing,etc)

Herpes Simplex-fever blisters, cold sores: | type 1

mouth, lips, face

Herpes Simplex-fever blisters, cold sores: | type 2

genital

Herpes Simplex-fever blisters, cold sores: | where are they found

outer lips and attached gingiva

Herpes Simplex symptoms (4)

* Prodromal signs-tingling, itching, pain, burning. Arise 6-24 hours before lesions develop. * multiple fluid-filled blisters * merge and collapse * yellowish crust

healing time for Herpes Simplex

2 weeks

Herpes Simples is a --- that is dormant in --- cells

virus | nerve cells

Herpes Simples recurs with

immune weakness (stress, fever, illness, injury, sunburn)

HERPETIC WHITLOW (3)

INFECTIONS OF THE THUMBS OR FINGERS. •GROUPED, FLUID OR PUS FILLED. •USUALLY, ITCH AND /OR PAINFUL

In the past. Primary herpetic gingivostomatitis was treated symptomatically; however, if the infection is diagnosed early, --- medications can have a significant influence

antiviral

Acyclovir suspension-

initiated during the first 3 symptomatic days in a rinse-and-swallow techniques 5x/day for 5 days. Significant acceleration in clinical resolution is seen.

treatment is complete when

development of new lesions ceases

Recurrent herpes labialis is best treated in the --- phase.

prodrome

what decreases the number of vesicles?

Acyclovir ointment /cream | But clinically minimal reduction in healing time and pain.

treatment can include (3)

Systemic acyclovir, valacyclovir, and famciclovir

For patients, whose recurrences appear to be associated with dental procedures, a regimen of

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

In immunocompromised patients, the viral load tends to be high, and replication is

not suppressed completely by antiviral therapy

Aphthous Ulcers (“Canker Sores”) (6)

``` •60% of U.S. pop. •starts around 10-20 yrs. old •frequency varies •prodromal tingling or burning sensation-usually 1-2 days before the ulcer appears •3 days pain, 7 days healed •If mild disease-treatment is topical corticosteroids. ```

Aphthous Lesions: | Although no single triggering agent is responsible, the mucosal destruction appears to represent a

T-cell mediated immunologic reaction

Aphthous Lesions: Tends to occur along family lines. When both parents have a history of aphthous ulcers, there is a --% chance that their children will develop the lesions.

Aphthous Lesions: | 3 clinical variations

Minor, Major, Herpetiform

MINOR APHTHOUS ULCERATIONS: | Patients experience fewest --- and --- duration

recurrences | shortest

MINOR APHTHOUS ULCERATIONS: Ulcers arise almost exclusively on --- --- and may be preceded by an erythematous macule in association with prodromal symptoms of burning, itching, or stinging.

nonkeratinized mucosa

MINOR APHTHOUS ULCERATIONS: | The ulcerations measure between ---m in diameter, oval, and heal without scatting in ---

3-10m | 7-14 days

MINOR APHTHOUS ULCERATIONS: | Usually, --- lesions and the pain is often out of proportion for the size of the ulceration.

1-5

MINOR APHTHOUS ULCERATIONS: | what is affect most frequently?

Buccal and labial mucosa are affected most frequently followed by the ventral surface of the tongue

MINOR APHTHOUS ULCERATIONS: | recurrence rate

highly variable, | ranging from one ulceration every few years to two episodes per month.

which has the longest duration per episode?

MAJOR APHTHOUS ULCERATIONS

MAJOR APHTHOUS ULCERATIONS: | size

Ulcerations are deeper and can take 2-6 weeks to heal

MAJOR APHTHOUS ULCERATIONS | may cause

scarring

MAJOR APHTHOUS ULCERATIONS | lesions

vary from 1-10

MAJOR APHTHOUS ULCERATIONS | onset

after puberty

Greatest number of lesions and most frequent recurrence:

HERPETIFORM APHTHOUS ULCERATIONS

HERPETIFORM APHTHOUS ULCERATIONS | size

small 1-3mm with as many as 100 ulcers present in a single recurrence. • Because of their small size and large number, the lesions bear a superficial resemblance to a primary HSV infection

HERPETIFORM APHTHOUS ULCERATIONS: | Common for individual lesions to coalesce into

larger irregular ulcerations

HERPETIFORM APHTHOUS ULCERATIONS: | Heal within -- days, but the recurrences tend to be closely spaced

7-10

HERPETIFORM APHTHOUS ULCERATIONS: | Many patients are affected almost constantly for periods as long as

3 years

HERPETIFORM APHTHOUS ULCERATIONS | what is involved?

any oral mucosa

HERPETIFORM APHTHOUS ULCERATIONS predominance onset

female | adulthood

Canker Sores (aphthous ulcers) ▪Minor: ▪Major: ▪Herpetiform:

Minor: ▪<1 cm and shallow Major: ▪> 1 cm and deeper ▪May scar when heal Herpetiform: ▪more numerous and vesicular

aphthous ulcers treatment •Symptomatic (2) •Local anti-inflammatory: (1) •Sealing agent (1)

* Viscous benzocaine * Orajel, Anbesol * Kenalog in Orabase Paste 2-4x / day * Ameseal, etc.

only FDA approved tx for canker sores (aphthous ulcers)

aphthasol

aphthasol (3)

* Paste = barrier * Apply 2-4x / day * Must start early (prodromal stage)