Oral Health

Aphthous lesions

Lichen planus

Oral Hairy Leukoplakia

Tonsilith

Vocal chord polyp

Torus

What are the mucosal disorders?

Aphthous Lesions

-Pathogenesis not clear (“Cankersore)

• FH, stress, late bedtimes contribute

-most common oral lesion

-Non-keratinized mucosa is the only place this occurs

-Painful

-7-10 day duration

Recurrent Aphthous Stomatitis (RAS)

-Reduced salivary peroxidase

-Associated with increased salivary levels of interleukin-2 and cortisol

-Often a sentinel event for ulcerative colitis relapse

Lichen Planus

-Skin and mucosal inflammatory auto-immune disease

• Oral mucosa has white streaks on it.

-Oral manifestations are most common, and usually precede skin lesions if it becomes severe

-Three oral manifestations:

• Wickens stria (most common, painless)

• Erosive (Painful)

• Bullous (painful)

Oral Hairy Leukoplakia (OHL)

Etiology: Epstein Bar virus

Demographic: Immunocompromised, often found in HIV/AIDS

-Careful history

-Refer for biopsy

Vocal Chord Lesions

Nodule:

• Trauma/overuse

• Usually bilateral

• Occasional hoarseness

Polyp:

• Often associated with smoking

• Hoarseness, dysphonia

• Malignant transformation risk

Cyst:

• Mucous retention

• Sebaceous

• Altered voice quality possible

Candidiasis (Thrush)

Cause: Candida Albicans (fungus)

• Opportunistic infection

• Alteration of normal oral flora balance

  • Antibiotics

  • Immune suppression

  • Topical steroids

  • Seeding by dentures

Treatment:

• Topical antifungals (Nystatin, Myconizole)

Median Rhomboid Glossitis

-Deep candidal infection of central tongue

-Erythematous, smooth, firm

Treatment:

• Systemic antifungal (Diflucan)

Tonsilitis

Pharyngitis

Laryngitis

Epiglottitis

What are the different pathologies that lead to a “sore throat”

Acute Tonsillitis

-60-70% viral, 30-40% bacterial (most common: group A strep.)

Signs/Symptoms:

• Rapid onset, Sore throat/fever

• Tonsillar enlargement

• Dysphagia

• Painful cervical lymphadenopathy

Centor Criteria (likelihood of GpA strep infection)

• Tonsillar exudate

• Painful neck nodes

• Hx of fever,

• no cough.

• ages 5-15

DX:

• Rapid step test, throat culture if test is negative and suspicion is high

Treatment:

• Viral: pain relief, salt water gargles, steroids?

• Bacterial: Above plus antibiotics, steroids?

• if chronic (>5/yr)…

  • Adults: surgery

  • Children: Medical therapy or surgery

Peritonsillar Abscess

-Complication of acute, or acute exacerbation of chronic tonsillitis

• Impending medical emergency

Treatment:

• Surgical incision and drainage

Pharyngitis

-Supraglottal, nasopharyngeal inflammation

-non-specific clinical sign (classic “sore throat”_

Etiology: Viral cold, strep throat, post nasal rhinorrhea, Mono, Severe xerostomia.

Dx:

• Thorough history/physical exam

• Consider rapid strep or Throat culture

Treatment:

• Treat underlying disease if isolated

• Treat symptoms.

Laryngitis

-Inflammation of the larynx (voice box)

Acute:

• < 3 weeks, Viral URI

• Trauma (coughing, overuse)

Chronic:

• >3 weeks

• Smoking, allergies, acid reflux

• Rheumatoid arthritis, TB, Sarcoidosis

S/S:

• hoarseness, fever, cough, pain,

• “lump in my throat”

• Dysphagia

• concerning:

  • Stridor

  • Hx of radiation therapy

Epiglottis

-Rapid onset swelling/edema of the epiglottis

-Causes:

• H. Flu type B

• Strep.

• Thermal injury/Chemical injury (e.g. firefighters)

Signs/symptoms:

• Drooling, difficulty swallowing

• Strider, dyspnea

• Fowar head posturing

• Cyanosis

Treatment:

• MEDICAL EMERGENCY

• Oxygen, Hospitalization

• Immediate airway management

  • Need an endotracheal cricoid tube, typically cannot intubate.

• Antibiotics/steroids

Herpes Simplex

Prodromal symptoms

• Vesicles, open wounds

• Yellow cicatrix (scab)

-Can occur on both keratinized/non-keratinized tissue (primarily on the lips)

-Virus may remain dormant in neural fibers after healing

-Recurrence with trauma, stress, and sun exposure.

Treatment:

• Topical Acyclovir

Herpes Stomatitis

Diagnosis:

• Clinical

Signs/Symptoms

• Fever, Halitosis

• Refusal to eat/drink (pain)

• Cervical lymphadenopathy

• Multiple intra/extraoral eruptions of painful ulcers. (widesread)

Differential:

• Coxacki viral infection (hand/foot/mouth)

• Aphthous stomatitis

• Candida albicans

• SJS.

Treatment:

• Oral or parenteral Acyclovir

Acute Necrotizing Ulcerative Gingivitis (ANUG)

-Unique form of periodontal disease

• Rapid onset, necrosis of interdental gingiva

• Pain, halitosis, bleeding.

Risk factors:

• Malnutrition, Immunocompromised (HIV/AIDs)

• Stress, poor oral hygiene

-suspect odontogenic etiology

-Suspect airway compromise

For Oropharyngeal space infections ALWAYS»>>

Ludwig’s Angina

-Bilateral sublingual and submandibular space infections.

Treatment:

• I&D

• Antibiotics

Retropharyngeal abscess

In children….

• 1-4 y/o

• Spread from other ear/nose/throat primary infections

• Airway compromise (untreated)

• Treatment:

  • antibiotics

  • Rare need for surgical intervention

In adults….

• Often spread of other space infections

• Often odontogenic

• Polymicrobial

• Danger space #4

• Treatment:

  • Surgical intervention and antibiotics

Major Salivary gland infections

-Viral infection of the parotid salivary gland (mumps)

• Rare, highly infectious

• Children: self-limiting.

• Adults: complications more frequent

  • Testes, breasts, ovaries, pancreas, meninges, decreased fertility, rarely → sterilization (males).

Bacterial causes (occur due to reduced flow of saliva)

• Sialolithiasis

• Mucous plug

• Post-radiation, drug-induced

• Xerostomia

• Sjogren’s disease

• Ductal trauma/scarring.

-Infections of the minor salivary glands are exceedingly rare.

Mucocele

-A fluid-filled cyst that forms in the oral mucosa (typically the lips)

Subtle/obvious swelling

Asymmetry

Non-specific pain

Facial/tongue paralysis (cranial nerve exam)

Non-healing ulcers

Habits (alcohol, tobacco, etc..)

HPV vaccine hx

Unusual pigmentation

What are the general principles to take into account when determining if a lesion could be cancerous?

Squamous Cell Carcinoma

-95% of oral malignancies

• Oral: Vast majority are environmental

• Pharyngeal: HPV

Internal Derangements

• Intra-articular disorders

Myofascial disorders

• Muscles/ligaments

What are the two categories for TMJ disorders?

Internal Derangements

Characteristics:

• Pain is specific to preauricular area

• There is, or used to be “popping” or “clicking” on jaw movement. this may be episodic

• Almost always unilateral

• Often deviation of midline on wide opening

• Possible hx of trauma/FH

Myofascial Disorders

Characteristics:

• Pain is described as non-localized and episodic

• some degree of spasm of one or more masticatory muscles

• Stress implications (usually manifested in unconscious clenching of teeth)

• Often but not necessarily bilateral

• Pain with mandibular function and often at rest

• May/may not be associated with joint noise