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Medicine I: HEENT > Oral and Mucosal Disease > Flashcards

Oral and Mucosal Disease Flashcards

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1
Q

Causes of Dental Carries

A

Contributing factors:
Bacteria: S. mutans, lactobacillus, actinomyces (Produce acid, demineralize teeth)

Diet: Sugary, sticky foods, Frequency of sugar intake

Appearance of carious lesions:

  • -Chalky & white (early)
  • -Brown or black spots (later)
  • -Destruction of tooth tissue (cavity)
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2
Q

Most common teeth affected by dental carries:

A

Most common: Permanent 1st molars

“6 year molars”-present the longest

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3
Q

Caries Prevention:

A 
Fluoride!
Optimal oral hygiene
Floss 1x/day
Brush 2x/day with fluoridated toothpaste
Rinse 1x/day with fluoridated mouthwash (ACT)
Diet
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4
Q

Dental Abscess:

A

Acute inflammation (collection of neutrophils, aka pus) associated with a tooth, gum tissue or bone

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5
Q

Causes of Dental Abscesses:

A

Causes:
Most common: tooth decay extends into the pulp of the tooth infection spreads into the adjacent bone
Can also result from severe periodontal disease

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6
Q

Presentation of Dental Abscesses:

A

Initially presents as tenderness of tooth
Progresses to intense pain w/ sensitivity
May have headache, fever, chills, swelling, lymphadenopathy, drainage

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7
Q

Tx of Dental Abscesses:

A

Reduction & elimination of infection
Root canal treatment & restoration
Extraction
Incisional drainage if bone or soft tissue expansion

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8
Q

Prevention of Dental Abscesses:

A

Good oral hygiene
Regular dental visits
Seek treatment as soon as possible

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9
Q

Untreated Dental Abscesses:

A

Ludwig’s angina:
Extension of infection into soft tissues of floor of mouth and neck, results in airway compromise
……………..
Cavernous sinus thrombosis:
Extension to cause blood clot in the cavernous sinus of the brain

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10
Q

Gingivitis:

A

Inflammation of the gingiva without destruction of the underlying bone
Affects almost 100% of population by age 50
Reversible with optimal oral hygiene

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11
Q

Complications of Gingivitis:

A

If untreated, can progress to periodontitis

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12
Q

Gingivitis Presentation:

A

Red, inflamed gingiva that bleeds easily….

Gums may be swollen, tender or painful

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13
Q

Causes of Gingivitis:

A 
Poor oral hygiene
Hormonal influences
Immune dysfunction
Tooth crowding
Mouth breathing
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14
Q

Tx of Gingivitis:

A

Eliminate underlying causes

Professional cleanings

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15
Q

Drugs that commonly cause Hyperplastic Gingivitis:

A

Phenytoin (anticonvulsant)
Nifedipine (calcium channel blocker)
Cyclosporine (immunosuppressant)

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16
Q

Necrotizing Ulcerative Gingivitis

A 
AKA Vincent’s infection
Occurs with psychologic stress
Military service (trench mouth)
.........
Blunted with “punched-out” necrosis covered by gray pseudomembrane
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17
Q

Causes of Necrotizing Ulcerative Gingivitis:

A 
Several bacteria & possibly viruses
Other causative factors:
Immunosuppression
Smoking
Poor oral hygiene
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18
Q

Presentation of Necrotizing Ulcerative Gingivitis:

A

Swollen, necrotic gingiva
Fetid odor
Exquisite pain
Fever, lymphadenopathy, malaise

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19
Q

Tx of Necrotizing Ulcerative Gingivitis:

A

Debridement (dental cleaning)

Antibiotics, chlorhexidine

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20
Q

Complications of Necrotizing Ulcerative Gingivitis:

A

If untreated, disease can spread:
Necrotizing ulcerative periodontitis (bone)
Necrotizing ulcerative mucositis (oral soft tissue)
Cancrum oris (Noma) (skin)

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21
Q

Periodontitis

A

Inflammation of the periodontium (soft tissues and bone surrounding teeth)
Progressive loss of the bone -> tooth loss

Most common cause of tooth loss in patients older than 35

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22
Q

Risk factors of Periodontitis:

A 
Risk factors:
Advancing age
Smoking
Diabetes mellitus
Osteoporosis
HIV infection
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23
Q

Presentation of Periodontitis

A 
Blunting & apical positioning of gingival margins
“Long in the tooth”
Deep periodontal pockets 
Bone loss
Tooth mobility
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24
Q

Tx of Periodontitis:

A

Chronic Periodontitis:
Professional deep cleaning (scaling and root planing)
Improved oral hygiene
Severe cases the teeth may be non-salvageable and extraction is needed

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25
Prevention of Periodontitis:
Control underlying disease Professional cleanings Improved home care
26
Recurent aphthous ulcerations (RAU) :
AKA Canker sores | Most common oral mucosal pathoses
27
Minor aphthous ulcerations:
Fewer recurrences & shorter duration Occur almost exclusively on nonkeratinized mucosa Yellow or white, removable membrane encircled by erythematous halo 1-5 lesions per episode Heal without scarring within 2 weeks
28
Major aphthous ulcerations:
Larger & more recurrences Most common locations: Labial mucosa (inside of lips) Deeper than the minor variant smaller, 1-10 lesions per episode Heals with scarring within 6 weeks
29
Herpetiform aphthous ulcerations:
Greatest number of lesions & most recurrences small, Up to 100 (may coalesce into larger ulcers) Heal without scarring within 1 week
30
Tx of recurrent aphthous ulcers:
Most patients need do NOT need treatment OTC anesthetics or topical medicaments Do NOT use silver nitrate
31
Herpes Simplex Infection:
Causes: HSV-1& HSV-2
32
Conditions linked to recurrent eruptions of herpes:
``` Stress Heat Allergy Trauma Menstruation ```
33
Primary HSV infection:
Abrupt onset with constitutional symptoms Mild to severely debilitating Produce lesions throughout mouth Only time herpes lesions appear on movable mucosa in healthy patients Numerous small vesicles; rapidly collapse to form numerous, small red lesions Resolves within 2 weeks
34
Recurrent HSV infection:
Prodromal signs 1 day before lesion develops Most common site = lips (cold sore or herpes labialis) Intraorally, only occurs on non-movable mucosa Multiple, painful, erythematous, tiny papules develop & form clusters of fluid-filled vesicles Resolves within 10 days
35
Dx of Herpes:
If patient claims (s)he was infected with herpes in your office, perform IgG/IgM testing. Generally: IgM in new cases IgG in recurrent cases
36
Tx of Herpes:
Treat with antivirals during primary herpetic infections to decrease recurrences
37
Candidiasis:
Most common fungal infection in oral cavity
38
Causes of Candidiasis:
Opportunistic fungal infection | C. albicans, part of the normal oral flora
39
Presentation of Candidiasis:
``` Variable clinical presentation: Pseudomembranous Erythematous Denture stomatitis Angular cheilitis Median rhomboid glossitits ```
40
Pseudomembranous Candidiasis:
AKA “Thrush” White, cottage-cheese like plaques that can be wiped off, leaving erythematous tissue Patients may have burning or unpleasant taste
41
Denture stomatitis:
Patients wear dentures 24 hours per day | Erythematous outline matches fit of denture
42
Angular cheilitis:
Patients with no or old dentures that “overclose” Saliva pooling at commissures of lips Licking dry, cracked corners of mouth makes it very difficult to heal
43
Median Rhomboid Glossitis:
Posterior midline of dorsal tongue | Symmetric loss of papilla which leaves a reddened, bald pattern
44
Tx of Candidiasis:
Topical antifungals Nystatin (high resistance): rinse, cream, or ointment Clotrimazole or other “-azoles”: troches or cream
45
Erythema Multiforme:
Blistering, ulcerative mucocutaneous condition
46
Causes of Erythema Multiforme:
``` Infection (herpes simplex, M. pnuemoniae) Drug exposure (antibiotics or analgesics) ```
47
Presentation of Erythema Multiforme:
Acute onset, may see fever, malaise, headache, cough, sore throat one week before onset Skin lesions: erythematous target or bull’s eye shape lesions Lips: hemorrhagic crusting of the vermillion border
48
Severe Forms of Erythema Multiforme
Stevens-Johnson syndrome | Toxic epidermal necrolysis
49
Treatment for Erythema Multiforme
Eliminate causative medication if possible Viral trigger: can treat with Acyclovir Supportive/Emergency medical treatment in severe cases IV rehydration, IV immunoglobulins
50
Lichen Planus
Chronic mucocutaneous disease Lesions can appear on any mucosal surface (including genital areas) & skin Cause: Immunologically mediated
51
Triggering Factors of Lichen Planus:
``` Triggering factors: S - stress T - trauma A – Advil (*all NSAIDs) Y – yeast (candidiasis) ```
52
Reticular Lichen Planus
More common type Asymptomatic Presentation: Wickham’s striae Appears as white plaques on tongue No ulcerations
53
Erosive Lichen Planus
Less common Symptomatic Presentation: Unilateral or bilateral ulcerations Affects buccal mucosa, tongue or gingiva Atrophic or ulcerated erythematous areas with surrounding border of white lines Biopsy required to rule out other conditions
54
Wickham’s striae:
Appears bilaterally on buccal mucosa as a “lace-like network of white lines”
55
Tx of Lichen Planus:
Treatment: Reticular- No treatment needed Erosive- Topical corticosteroids
56
Mucous Membrane Pemphigoid
Chronic, blistering, autoimmune disorder affecting mainly mucosal surfaces Autoantibodies causes sub-epithelial separation
57
Most common sites of Mucous Membrane Pemphigoid:
Lesions most common on gingiva Vesicles or blood filled blisters Blisters rupture leaving painful ulcerations Most significant complication is ocular involvement in 25% of pts Scarring eye lesions result in blindness in 10%
58
Tx of Mucous Membrane Pemphigoid
Topical or systemic corticosteroids Low dose antibiotics Excellent oral hygiene
59
Pemphigus Vulgaris
Autoimmune vesiculobullous disorder, usually affects the skin, may show oral mucosal involvement Autoantibodies cause intraepithelial split
60
Presentation of Pemphigus Vulgaris:
Oral lesions are typically the first sign Superficial, ragged erosions & ulcerations throughout oral mucosa
61
Tx of Pemphigus Vulgaris:
Systemic corticosteroids
62
Complications of Pemphigus Vulgaris:
Before corticosteroid tx, 90% died due to infections & electrolyte imbalances Now, mortality rate 5-10%, usually due to complications of long-term corticosteroids

Medicine I: HEENT (13 decks)

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