Oral/Oropharnyx Diseases

Question 1

This disease presents purulence and pain in a tooth, also commonly referred to as “an abscessed tooth”

Answer 1

Acute periapical periodontitis

Question 2

How would you treat a patient with an acute periapical periodontitis?

Answer 2

Abx and referral

Question 3

What unique physical examination finding might you see on a patient with an acute periapical periodontitis?

Answer 3

Fistula

in the gums - these can come and go, and are created by an increase in pressure

Question 4

You may likely see biphosphonate osteonecrosis in patient who wear what?

Answer 4

Dentures

Question 5

These are white patchy calluses also commonly referred to as Leukoplakia

Answer 5

Hyperkeratosis

Question 6

T/F: Hyperkeratosis (Leukoplakia) can be rubbed or scraped off?

Answer 6

False

Question 7

This disease is more worrisome than typical leukoplakia and is typically caused by chemicals (ie. alcohol, tobacco)

Answer 7

Epithelial Dysplasia

Question 8

_____ _______ is typically caused by irritation from smoking and presents as thick luekoplakia on the surface of the tongue?

Answer 8

Hairy Tongue

Question 9

Another common source of hairy tongue is what virus?

Answer 9

EBV

Question 10

This disease presents as a lacy “rash” on the buccal mucosa, it can become ulcerated.

Answer 10

Oral Lichen Planus

Question 11

Oral Lichen Planus is more present in what age range?

Is it more common in men or women?

Answer 11

> 50 y.o.

Women > Men

Question 12

Why should Oral Luchen Planus be referred to a dental specialist?

Answer 12

Because 1% can become Small Cell Carcinoma

Need to r/o cancer

Question 13

Which are typically more ominous, erythroplakia or leukoplakia?

Answer 13

Erythroplakia

90% are dysplasia or carcinoma

Question 14

Erythroplakia on physical examination of the mouth is typically a sign of what?

Answer 14

Small Cell Carcinoma

Question 15

Why would erythroplakia and an atrophic tongue raise concern for cancer?

Answer 15

The tongue being atrophic is a sign of malnourishment, which may indicate the presence of cancer “commandeering” nutrients that would typically go to the tongue.

Question 16

Other than tobacco/alcohol use, what is the 2nd most common risk factor for oral cancer?

Answer 16

HPV (16, 18)

Question 17

What is the most common oral cancer?

Where is it located?

Answer 17

Squamous cell carcinoma

EVERYWHERE

Question 18

On physical examination, SCCa typically can be what?

Answer 18

Erythematous
Ulcerated
Indurated
Shifted Teeth

Question 19

Why is it important to refer a patient with SCCa to a dentist who has experience dealing with chemotherapy patients?

Answer 19

To help manage the severe side effects of chemotherapy

Question 20

This will often develop after chemotherapy, resulting in a dry mouth, and imminent tooth lose.

Answer 20

Xerostomia

Question 21

This is bone death due to radiation/

Answer 21

OsteoRadioNecrosis

(Radiation causes the vessels in the bones to shrink down, cutting off ‘nutrient & healing’ supplies, resulting in bone death)

Question 22

How is oral pseudomembranous candidiasis clinically diagnosed?

Answer 22

Presence of ‘white curds’ on an erythematous base that can be easily rubbed/scraped off

Question 23

What are three risk factors for oral candidiasis?

Answer 23

1. Immunocomprimised
2. DM
3. ABx usage

Question 24

This form of oral candidiasis does not easily rub off, is associated with smoking, and can commonly appear similar to Hairy Tongue or Oral Lichen Planus?

Answer 24

Hyperplastic Candidiasis

Question 25

This form of candidiasis presents with erythroplakia, stomatitis, and is often associated with a mucosal allergy

Answer 25

Erythematous Candidiasis

Question 26

This disease presents with white plaque on the lips and is typically seen in patients exposed to sunlight (ie. farmers)

Answer 26

Angular cheilitis

Question 27

T/F: Should you use "magic mouthwash" in patients with oral candidiasis?

Answer 27

False

Question 28

T/F: Treatment for oral candidiasis is anti-fungals?

Answer 28

True

Question 29

This disease occurs when there are patches of no papillae growth on the tongue, t often travels around, and is harmless requiring no treatment

Answer 29

Geographic tongue

Question 30

This form of glossitis is typically related to B12, Vit E, or iron deficiencies.

Answer 30

Atrophic glossitis

Question 31

This disease is continuous neuropathic pain without any clinical signs, is typically bilateral, and most common in women >50 y.o.

Answer 31

Glossodynia (Burning Mouth Syndrome)

Question 32

This disease is also referred to as trench mouth and is tpically seen in stressed young adults.

Answer 32

Aucte Necrotizing Ulcerative Ginigivitis (ANUG)

Question 33

What are some common clinical signs of ANUG?

Answer 33

1. BAD Smell 2. Red, necrotic papillae 3. erythematous gums, bleed easily 4. Lymphadenopathy 5. Fever

Question 34

Which type of bacteria typically cause ANUG?

Answer 34

Spirochetes | Fusiform Bacteria

Question 35

What is the Tx for ANUG?

Answer 35

1. Rx for Metronidazole 2. Rx for Pencillin 3. Referral to DDS for debridement 4. Improve oral hygiene

Question 36

How would you distinguish between ANUG and Ginigivitis?

Answer 36

You would except a significant papillae lose in a patient with ANUG where as in Ginigivitis the papillae should still be intact with only areas of erythema

Question 37

These type of ulcers are typically located on unattached tissues, can be singular or multiple, and usually have a RED Halo around them.

Answer 37

Aphthous Ulcers

Question 38

T/F: Are Apthous Ulcers self-limiting?

Answer 38

Yes

Question 39

This oral disease presents as unilateral vesicles on attached tissues and is often referred to as 'cold sores'.

Answer 39

Oral Herpes Simplex

Question 40

In what type of patient population may herpes simplex not be unilateral?

Answer 40

Immunocomprimised

Question 41

What may children experience with oral HSV if it is their first exposure?

Answer 41

Herpangia (Fever, Red Soft Palate)

Question 42

How should you treat and manage oral HSV?

Answer 42

1. Topical Antivirals | 2. Avoiding exposing others

Question 43

What is the common prodrome to Oral HSV?

Answer 43

Tingling | Usually following stress

Question 44

This disease is a life threatening emergency in which sublingual/submandibular swelling crosses the midline.

Answer 44

Ludwig's Angina

Question 45

Other than submandibular/sublingual swelling, what symptoms might be present in Ludwig's Angina?

Answer 45

1. Raised Tongue 2. Fever 3. Dysphagia

Question 46

When would an I&D likely be indicated in a patient with Ludwig's Angina?

Answer 46

When there is palpable fluctuance

Question 47

How do you treat Ludwig's Angina

Answer 47

1. Hospitalization for IV ABx 2. Airway Management 3. Possible I&D

Question 48

What would be concerning for any infection in the head or neck that is left untreated?

Answer 48

Abscesses in the brain

Question 49

What is the most common bacterial etiology of pharyngitis? What is the most common viral etiology of pharyngitis?

Answer 49

Group A beta hemolytic streptococcus Rhinovirus

Question 50

What are the symptoms of of pharyngitis?

Answer 50

``` Sore throat Dysphagia Fever Exudate Cervial Lymphadenopathy ```

Question 51

How is pharyngitis primarily diagnosed? What additional diagnostic measure can be taken?

Answer 51

Clinically Throat Cultrue

Question 52

What is the first line treatment for pharyngitis? What would be second line if a patient had a penicillin allergy?

Answer 52

Penicillin Erythromycin

Question 53

What is the primary complication of pharyngitis?

Answer 53

Scarlet Fever

Question 54

What are unique symptoms of staphylococcal pharyngitis?

Answer 54

Mucopurulent discharge in the posterior oropharynx | Edema and pustules

Question 55

This disease is commonly referred to as "whooping cough" and is vaccine preventable.

Answer 55

Bordatella Pertussis

Question 56

What are the three stages of pertussis?

Answer 56

1. Catarrhal Stage 2. Paroxysmal Stage 3. Convalescent Stage

Question 57

Are Abx indicated to treat pertussis?

Answer 57

No, the disease is typically self-limited.

Question 58

This is the most common cause of epiglottitis in children ages 2-5 and is vaccine preventable.

Answer 58

Haemophilus Influenzae

Question 59

What Sx are associated with epiglottitis?

Answer 59

Sore throat, Fever, Dysphagia 4-10 hours after onset there can be drooling and airway compromise

Question 60

T/F: Epiglottitis is not an airway emergency

Answer 60

False, it is an airway emergency

Question 61

How is epiglottitis treated?

Answer 61

Airway management | ABx (Ampicillin, amoxicillin)

Question 62

What symptoms are unique to bacterial pharyngitis? What symptoms are unique to viral pharyngitis?

Answer 62

Bacterial... 1. mucopurulent discharge 2. high fevers 3. Longer Viral...... 1. Myalgias 2. Fatigue 3. Negative Cx

Question 63

How is viral pharyngitis treated?

Answer 63

Self-limited

Question 64

Oral thrush is typically caused by what?

Answer 64

Candida albicans

Question 65

What may cause a proliferation of candida? (TWO)

Answer 65

1. Immunocompromised | 2. ABx use

Question 66

What Sx are associated with candida albicans?

Answer 66

Sore throat Dysphagia White "cheesy" plaque in the oral cavity/pharynx

Question 67

How is oral thrush treated?

Answer 67

Topical Nystatin | Sometimes systemic ketoconazole

Question 68

This occurs when there is an infection in the tonsillar fossa (b/w the muscle and the posterior pharynx)

Answer 68

Peritonsillar abscess

Question 69

T/F: Peritonsillar abscesses are a life-threatening, ENT emergency

Answer 69

True (it can progress to life threatening mass lesions)

Question 70

What would be concerning if a peritonsillar abscess became too large?

Answer 70

1. Airway compromise 2. Septic shock (abscess can break through the muscle and into the carotid/jugular) 3. IJV thrombosis 4. Carotid blowout

Question 71

What are the symptoms associated with a peritonsillar abscess?

Answer 71

``` Sore throat Trismus Dysphagia Fever Uvula deviation Soft palate swelling Drooling “Hot Potato” voice ```

Question 72

How is a peritonsillar abscess treated?

Answer 72

1. Drainage 2. Fluid replacement 3. Airway management 4. Antibiotics (IV Ampicillin)

Question 73

If you had recurrent peritonsillar abscesses (more than 2) what would you recommend?

Answer 73

Tonsillectomy

Question 74

This is usually caused by a suppurative lymph node as well as by trauma in children <5 y.o.

Answer 74

Retropharyngeal Abscess

Question 75

What is the most concerning complication of a retropharyngeal abscess?

Answer 75

Infection spread to the mediastinum (~40%mortality rate)

Question 76

What are the symptoms of a retropharyngeal abscess?

Answer 76

``` Fever Neck swelling Dysphagia Respiratory distress Nuchal rigidity ```

Question 77

What are some of the clinical findings of a retropharnygeal abscess?

Answer 77

Cervical lymphadenopathy Bulging of posterior pharyngeal wall Tilting of head to unaffected side

Question 78

How is a retropharyngeal abscess diagnosed?

Answer 78

1. Clinically 2. Lat. XRay soft tissue 3. CT

Question 79

How is a retropharyngeal treated?

Answer 79

1. Airway management 2. IV Antibiotics (small abscess) 3. I&D + ABx (Large Abscess)

Question 80

This is the most common indication for a tonsillectomy

Answer 80

Tonsillar hypertropy

Question 81

What are common symptoms/complications of tonsillar hypertrophy?

Answer 81

1. Snoring 2. Dysphagia 3. Disturbed sleep patterns 4. Nocturnal choking/coughing 5. Failure to thrive 6. Severe OSA

Question 82

If the symptoms were severe enough, how would you treat tonsillar hypertrophy?

Answer 82

T&A

Question 83

Why would asymetrical tonsils be concerning? (When not infectious)

Answer 83

It would be concerning for neoplasm which is concerning for cancer

Question 84

With this disease patients complain of "feeling like food is getting stuck" and typically is associated with bad breath and dysphagia.

Answer 84

Tonsilloliths

Question 85

How are tonsilloliths treated?

Answer 85

1. Gargles and Rinses 2. "Water Pik" 3. Tonsillectomy

Question 86

Are ABX indicated to treat tonsilloliths?

Answer 86

No

Question 87

This is disease is an acutely inflamed mucosa in the mouth, often referred to as a soreness, and can be caused by dehydration, poor hygiene, and medications.

Answer 87

Stomatitis

Question 88

How is stomatitis treated?

Answer 88

1. Stop "drying" medications 2. Improve oral hygiene 3. Increase moisture

Question 89

What type of ulcer is commonly seen with stomatitis?

Answer 89

Aphthous Ulcers

Question 90

This occurs when the corners of the mouth appear chapped.

Answer 90

Angular Cheilitis

Question 91

Is angular cheilitis usually fungal, viral, or bacterial?

Answer 91

Fungal

Question 92

How is angular cheilitis treated?

Answer 92

Antifungals

Question 93

This is severe disorder presents with tongue and lip swelling often leading to airway obstruction

Answer 93

Oral angioedema

Question 94

How would an airway obstruction be handled in a patient with oral angioedema that could not be intubated?

Answer 94

Tracheostomy

Question 95

What medication is angioedema a side effect of? What else can it occur from?

Answer 95

ACE Inhibitors for HTN Allergies

Question 96

What are three types of Sialadenitis?

Answer 96

Parotid Submandibular Minor

Question 97

What is Sialadenitis?

Answer 97

Diffuse painful swelling of the salivary glands typically exacerbated with eating

Question 98

What typically causes sialadenitis?

Answer 98

1. Dehydration from illness or medications | 2. Trauma to the duct

Question 99

How is sialandenitis treated?

Answer 99

1. Augmentin 2. Steroid dose 3. Sialagogues

Question 100

This disease is caused by similar organism as tonsillitis/pharyngitis and presents as a hoarseness in the patients voice as well as a cough

Answer 100

Laryngitis

Question 101

Is symptoms persist for more than 2-3 weeks what may be warranted?

Answer 101

Endoscopy ("take a look down")

Question 102

What is another common cause of laryngitis other than viral/bacterial?

Answer 102

GERD

Question 103

This is typically caused by a dental abscess that spreads to the sublingual and submandibular spaces forcing the tongue backward

Answer 103

Ludwig's Angina

Question 104

Is Ludwig's Angina an ENT emergency? What is the most concerning immediate complication?

Answer 104

YESSSSSS Airway obstruction

Question 105

How is Ludwig's Angina treated?

Answer 105

1. Airway management (Tracheostomy, Intubation) 2. I&D of dental abscess 3. Tooth extraction 4. IV Abx

Question 106

What virus is Hand, Foot, and Mouth disease commonly caused by?

Answer 106

Coxsackie

Question 107

Is Hand, Foot, and Mouth disease more common in children or adults?

Answer 107

Children

Question 108

What is a unique physical exam finding of Hand, Foot, and Mouth Disease

Answer 108

Characteristic blisters on the hands, feet, and ulcerative lesions in the mouth (can also have diarrhea)

Question 109

How is Hand, Foot, and Mouth disease treated?

Answer 109

Conservative Management