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Flashcards in Oral disorders Deck (38):
1

clinical patterns of oral pathology?

- ulcers
- keratosis
- swelling
- vesicles (viral)
- pigmentation changes
- combo of the above

2

Primary factors contributing to oral disease?

- smoking/ETOH
- systemic disease: infections, diabetes (immunocompromised) - thrush due to hyperglycemic levels which promote enviro for yeast to grow
- anemia
- bowel disease
- autoimmune disease (bechet's)
- meds - dexamethasone can be prone to candida
- stress/hormonal changes
- genetics

3

What is oral frictional hyperkeratosis?

- excessive growth of stubbornly attached keratin, may happen for number of reasons and may be genetic, physiological, pre-cancerous, and cancerous
- change may result from chemical, heat or physical irritants. It isn't known to be infectious
- habit of cheek biting, chewing or tongue thrusting can usually be ID'd as responsible irritant if site of the white patch is examined in careful relationship to level at which teeth meet

4

Local infections examples?

- dental caries/acute pulpitis
- gingivitis/periodontitis
- dental abscesses
- necrotizing periodontal disease (vincent's angina)
- ludwig's angina
- fever blister or cold sores
- herpangina
- thrush
- hairy tongue

5

Cause, PP, and sx of dental caries/acute pulpitis?

- cause: strep mutans and other bacteria
- PP: destroys hard tissues of teeth, progresses into dental pulp (acute pulpitis)
- sx:
hot/cold sensitivity
continuous throbbing pain (later)

6

Prevention and tx of dental caries?

- prevention: fluoride, brushing, flossing, mouthwashes, routine cleanings
- tx: simple caries - restoration
pulpitis: abx, NSAIDs, root canal may be necessary

7

High risk populations - dental caries?

- chemo
- diabetics
- xerostomia secondary to other causes (meds)

8

What is gingivitis (periodontitis)?

- inflammation of marginal gingiva
- earliest form of periodontal disease
- etiology:
anaerobes (cause of halitosis) most common cause
- clinical: usually painless, increased bleeding with brushing, soft tissue separation (pocket formation)

9

Periodontal abscess PP, Tx and prevention?

- PP: gingival soft tissue inflammation, infection
- clinical: edema, erythema, pyorrhea, pain
- tx: oral abx (PCN or clindamycin), NSAIDs (prn)
- prevention: good oral hygiene (brushing, flossing, antibacterial mouth rinses, removal of impacted food debris, routine visits to dental hygienist)

10

Acute necrotizing ulcerative gingivitis signs/sxs and tx?

- AKA vincents angina (trench mouth)
- signs/sxs: halitosis, ulcerations fof interdental papillae
- tx: PCN (po) + metronidazole
- clindamycin (alone)

- strongly assoc with HIV but not pathognomonic

11

Ludwig's angina pp, signs/sxs, tx?

- pp: rapidly spreading cellulitis of SL and submandibular spaces
usually begins as infected lower molar
- signs/sxs: febrile, drooling, trismus, edema in SL area spreading down neck

- tx: IV abx covering strep and oral anaerobes
- PCN or unasyn of a b lactam and b lactam inhibitor
- plus metronidazole (flagyl) 500 mg PO tid (metallic taste in their mouth)

12

Herpetic lesions? Presentation, and tx?

- cold sores (fever blisters) or painful vesicles on tongue/buccal mucosa
- etiology: HSV1 or 2
- lesions:
vesicles
white coated tongue
ulcerative gingivitis
lip lesions
facial lesions

tx:
acyclovir (zovirax) 400 mg 5x/day
valacyclovir 1000 tid

13

Herpangina
etiology?
clinical features?
Tx?

- picornovirus (not herpes) called coxsackie virus
- clinical features:
painful, fever, malaise, sore throat
- vesicles are present on soft palate, 7-10 days
- tx: supportive, analgesics

** any sore in mouth give 2 weeks but if not healed by this time refer!

14

Oral candidiasis
etiology
signs/sxs
tx?

- Candida sp
- occurrence: neonates, prolonged abx use, immunocompromised pts
- signs/sxs: white plaques on tongue/oral mucosa, burning tongue, raw throat
- tx: topical antifungals: clotrimazole (mycelex) troches or nystatin (swish and spit/swallow)
- oral fluconazole (diflucan) - used with recurrent candidiasis, 200 mg one dose or 100 mg for 7 days

15

Hairy tongue? etiologies?

- elongation of filiform papillae of dorsal surface
- coloration due to staingin (by tobacco or food) or infection with chromogenic organisms (commonly fungi)

16

What are some mucosal dermatologic changes?

- aphthous stomatitis (ulcers) - aka canker sores
- geographic tongue
- oral leukoplakia
- oral cancer

17

Aphthous stomatitis etiologies?

- most common oral ulceration, seen in 10-20% of population
- thought to be auto-immune process numerous etiologies:
CMV
hormones
nutritional deficiency (vit B def)
- some studies report predilection for females - hormonal changes, common ages are puberty through age 22
- last 7-10 days

18

Management of aphthous stomatitis?

- sucralfate
- acidophilus
- folate
- vitamin B12
- stress relief
- licorice
- corticosteroids (dexamethasone or temovate)

19

What is a geographic tongue?

- asymptomatic inflammatory condition
- rapid loss and regrowth of filiform papillae causes denuded red patches to wander across surface of tongue

20

What is oral leukoplakia, PP, tx?

- benign epithelial hyperplasia
- strongly assoc with HIV infection
- clinical:
asx lesions usually lateral surfaces of tongue
- tx:
responds to high dose acyclovir (zovirax)

21

Oral cancer:
incidence, etiology and detection?

- 2-4% of malignancies in US, increases with age
- etiology:
tobacco/ETOH use, HPV
- detection:
all ulcerative oral lesions which fail to heal within 2 weeks should be bx
- these will be raised, white, not uniformly demarcated

22

Durg induced oral pathologies?

- most pharmaceuticals have oral side effects:
xerostomia (antihistamines, BP meds)
pigmentation changes
hyperplasia
mucositis

23

Causes of halitosis?

- lower resp tract infection: bronchiectasis, lung abscesses
- oral infections: caries, periodontal disease, acute necrotizing ulcerative gingivitis
- smoking
- hepatic failure (fishy)
- azotemia (ammonia)
- DKA (sweet, fruity)
- H. pylori
- esophageal cancer
- metal poisoning (garlicky)

24

Pharm causes of xerostomia?
Clinical presentation?
Tx?

- diuretics, drugs with anticholinergic effects - antihistamines, TCAs
- clinical presentation:
c/o oral dryness, burning of tissues, difficulty eating and swallowing, tongue irrititation, painful ulcerations, progressively increasing caries and periodontal disease
- tx:
saliva substitutes, salivary stimulation with sugarless hard candies

25

Causes of pigmentation changes?

- tetracycline: causes permanent discoloration of teeth and enamel hypoplasia if given during 2nd half of pregnancy or to children under 8
- sedatives, OCP, antimalarials: brown, black, or gray areas of oral mucosa pigmentation (disappears following drug cessation)
- amalgam tattoo: blue black pigmentation
- heavy metal pigmentation: bismuth, mercury, lead - thin blue black pigmented line along gingival margin

26

Meds that cause gingival hyperplasia?

- phenytoin (dilantin) - 40% of those tx
- CCBs (nifedipine)
- cyclosporin

- surgical removal of tissue is effective but hyperplasia recurs if drug isn't d/c

27

Mucositis?
etiology
clinical presentation?

- etiology: numerous chemotherapeutic agents, radiation therapy to head and neck cancers
- clinical: edema and painful chewing/swallowing of food

28

Systemic disease manifestations?

- diabetes
- anemia
- vitamin deficiency
- mono
- HIV/AIDS
- cancer
- bechet's disease

29

Diabetes and oral problems?

- acute gingival (periodontal) abscesses
- gingival proliferations/red-gingival hypertrophy
- dry burning mouth
- gingival tenderness/spontaneous bleeding
- lip dryness
- tooth mobility
- periodontal disease

- prevention: tight glucose control

30

Anemia and oral manifestations?

- pernicious anemia (vit B12 deficiency): glossitis - smooth, beefy, red and sore tongue
- Fe deficiency anemia:
glossitis - reddened, edematous, smooth, shiny, and tender tongue
angular cheilitis/stomatitis: erosion, tenderness and edema at corners of the mouth

31

Vitamin deficiency and oral manifestations?

- oral mucositis
- ulcers
- glossitis and burning sensations in the tongue (glossodynia) - common in B group deficiences
- petechiae
- gingival swelling and bleeding
- teeth loosening and ulcerations (common in VIt C deficiencies)

32

Mono presentation?

- palatal petechiae
- pharyngitis (with or w/o exudate)
- lethargy
- sore throat

33

HIV and oral manifestations?

predisposes pts to:
-oral candidiasis
-necrotizing ulcerative periodontal disease (vincent's angina)
- stomatitis (enterics)
- hairy leukoplakia
- AIDs pathognomonic oral lesions:
oral kaposi's sarcoma
oral lymphoma

34

Cancers and oral manifestations?

- acute leukemias (esp monocytic) - gingival bleeding, necrotic ulcers, gingival enlargement/hyperplasia due to massive infiltration of leukemic cells
- bluish gingival appearance
- oral infections and marked discomfort
- radiation therapy for head and neck cancer - severe oral mucositis with ulcers, candidiasis, bacterial infections and xerostomia

35

Facial problems?

- cheilosis (cheilitis)
- sialoadenitis/parotitis
- structural disorders:
TMJ, trauma/fractures

36

Presentation, etiology and management of cheilosis?

- presentation: inflammation and or fissuring of lips at corners
- etiology: enviro irriation (chapping), met/nutritional (diabetes, anemia, thyroid disease, vitamin deficiencies)
- poor fitting dentures
- infection

- management: eliminate cause

37

What is sialoadenitis? PP? clinical presentation?

- infections of salivary glands may be viral (mumps) or bacterial (usually secondary to obstruction)
- salivary stones (sialothiasis) usually occur in major duct of salivary gland
- often seen in elderly, debilitated, or post op pts who become dehydrated
- obstruction results in inflammation/infections of salivary glands
- clinical presentation: edema, pain (worse with eating, especially tart foods like lemons), purulent drainage may be obtained from duct orifice

38

TMJ dysfxn
clinical presentation
management?

- usually adult females
- unilateral pain (dull, aching, worsening throughout the day) in region of jaw, joint popping or crepitus, acute otalgia
- difficulty chewing or opening mouth widely
- burning sensation of tongue or palate
- bruxism (teeth grinding), tinnitus, vertigo - ledas to chgs in bite, ht of teeth
- acute tenderness over TMJ

management: physiotherapy - warm moist compresses 15 min qid for 7-10 days, pureed diet 1-2 weeks, analgesics and muscle relaxants