Oral Disease

Question 1

What symptom is a big risk factor for periodontal disease and dental caries?

Answer 1

dry mouth

Question 2

subjective complaint of dry mouth

Answer 2

Xerostomia

Question 3

objective reduction in salivation

Answer 3

Hyposalivation

Question 4

Why is dry mouth is very common in the elderly?

Answer 4

> 30% of people over 65

Salivation does not decrease with age – medical conditions and treatments are the cause

Question 5

Elderly patients with new onset dry mouth - what should you rule out/think of first?

Answer 5

worry about diabetes

Question 6

What are the mainstay of good oral hygiene and can prevent endocarditis?

Answer 6

Brushing and flossing

Question 7

Frequency of bacteremia is correlated to what?

Answer 7

poor dental and periodontal health

Question 8

List some drug causes of dry mouth

Answer 8

Calcium channel blockers
Anticonvulsants
Immunomodulatory agents
Anticholinergics
Sedatives
Antihistamines
diuretics

Question 9

List some causes of dry mouth

Answer 9

Sjogren’s disease
Dehydration
DM
Drugs
Ductal obstruction
Infections
Tumors
Radiation therapy

Question 10

What are some complications of dry mouth?

Answer 10

Reduces compliance with medications
Restricts dietary choices
Chronic esophagitis
GERD
Dental caries
Periodontal disease (Increases frequency and severity)
Dentures are not comfortable

Question 11

What are most common and are often secondary to medication-induced dry mouth?

Answer 11

Root caries

Question 12

In infants, how can you distinguish thrush from milk?

Answer 12

Cannot scrape off thrush – how to distinguish from milk

Question 13

How do infants typically present with thrush?

Answer 13

Mom may complain of fussy infant who is eating more than normal

Thrush is painful and the milk is soothing, so will ingest more

Question 14

Creamy-white, curd-like removable patches overlying erythematous
mucosa

Answer 14

Thrush

Question 15

What is the organism responsible for thrush?

Answer 15

Candida albicans

Question 16

What testing is used for the diagnosis of candidiasis of the mouth?

Answer 16

Wet prep KOH

Question 17

White, non-removable lesion – cannot be removed by rubbing the mucosal surface

Whitish, lacey appearance – patches or plaques of the oral mucosa

Chronic inflammatory disease

May be erosive

Answer 17

Leukoplakia

Question 18

Why is leukoplakia concerning?

Answer 18

2-6% represent SCC

1-20% will progress to carcinoma within 10 years

Question 19

Usually on tongue – affects lateral portions

One of the first manifestations of HIV

Not considered a pre-malignant lesion

White corrugated painless plaque

Answer 19

Oral Hairy Leukoplakia

Question 20

Epstein-Barr virus-mediated mucocutaneous disease – relatively specific for HIV infection

Answer 20

Oral Hairy Leukoplakia

Question 21

What is the responsible pathogen for oral hairy leukoplakia?

Answer 21

Epstein-Barr virus-mediated

Question 22

Red mucosal plaques

Compared to leukoplakia, these lesions are more likely to represent malignancy

90% dysplasia or CA

See in EtOH or tobacco use

Answer 22

Erythroplakia

Question 23

90% of oral cancers are what type?

Answer 23

SCC

Question 24

AKA Trench Mouth and Vincent’s Infection

Spirocetes and fusiform bacilli

Common in young adults under stress

Answer 24

Necrotizing Ulcerative Gingivitis

Question 25

AKA Canker sore and ulcerative stomatitis Painful, small round ulcerations with yellow-gray fibrinoid centers with surrounding red halo May be single or multiple, often recurrent Etiology is not certain

Answer 25

Aphthous Ulcer

Question 26

Aphthous ulcers are associated with what chronic disease?

Answer 26

Can be associated with bowel disease Can be the earliest manifestation of Crohns disease

Question 27

Although the etiology is not certain for aphthous ulcers, it is believed to be associated with what virus?

Answer 27

Associated with Herpesvirus 6

Question 28

Self limiting in most cases Vesicles on an erythematous base Treat with acyclovir, valacyclovir

Answer 28

Herpetic Stomatitis

Question 29

Inflammatory disorder of the tongue Tongue has a smooth, glossy appearance with a red or pink background – caused by atrophy of filiform papillae

Answer 29

Atrophic Glossitis

Question 30

What are some causes of atrophic glossitis?

Answer 30

Nutritional deficiencies Protein-calorie malnutrition Infection (Syphilis, Oral candida infection) Sjorgren syndrome Celiac disease

Question 31

Which nutritional deficiencies are associated with atrophic glossitis?

Answer 31

Iron Vitamin B12 folic acid Niacin

Question 32

Unknown etiology Possible similar etiologies as atrophic glossitis Loss of filiform papillae leads to ulcer-like lesions

Answer 32

Geographic Tongue

Question 33

What is the most common form of periodontal (gum) disease?

Answer 33

Gingivitis

Question 34

What is a precursor to periodontitis?

Answer 34

Gingivitis

Question 35

Inflammatory process – manifests as gingival redness and swelling Bleeding may develop when brushing or flossing the affected area Can be reversed with good, regular oral hygiene (brushing teeth, flossing, tartar removed by dentist, etc)

Answer 35

Gingivitis

Question 36

Characterized by gingival inflammation accompanied by loss of supportive connective tissues, including alveolar bone

Answer 36

Periodontitis

Question 37

What are some complications of untreated periodontitis?

Answer 37

If left unchecked, can lead to destruction of the periodontium and tooth loss Suppurative odontogenic infections may extend to facial spaces in the orofacial region (e.g. Ludwig’s angina – bilateral infection of the submandibular space) or deep in the head and neck

Question 38

What is the etiology of dental caries?

Answer 38

Caused mainly by microorganisms that generate acids on the tooth surface from disaccharides and monosaccharides