HEENT - Mouth & Throat

Caries epi

very common

Caries pathophys

colonizing plaques

Caries clinical presentation

asymptomatic to pain

Caries PE findings

craters, color change

Caries dx

clinical

Caries tx

treat sx, dental referral, prevention

Caries complications

abscess, infection

dental abscess pathophys

plaques invade gingiva

dental abscess clinical presentation

pain, swelling

dental abscess PE findings

dental abscess dx

clinical

dental abscess tx

pain relief

antibiotics

I&D

Gingivitis epi

common in childhood

Gingivitis pathophys

prevotella intermedia

Gingivitis clinical presentation

fever, swelling, bleeding

Gingivitis PE findings

erythema, maybe calculus

Gingivitis dx

clinical, may culture

Gingivitis tx

chlorhexidine rinse

abx

Gingivitis complications

tooth loss, infection

peridontitis pathophys

attachment loss of peridontal ligamnet

peridontitis epi

common

peridontitis clinical presentation

incidental, loose teeth

peridontitis PE findings

increased probing depth; mobility of teeth

peridontitis dx

clinical, loss of ligament attachment > 6 mm

peridontitis tx

debridement; prevention

peridontitis complications

abscess, tooth loss

Dental trauma epi

very common

Dental trauma pathophys

fractures to tooth/bone

luxation of supporting structures

Dental trauma clinical presentation

history of injury, pain, loose/missing teeth

Dental trauma PE findings

injury, pressure, sensitivity

Dental trauma dx

clinical, x-ray

Dental trauma tx

dental referral, replacement

Dental trauma complications

cosmetic

types of dental luxation injuries (6)

concussion

subluxation

intrusion

extrusion

lateral luxation

avulsion

Candidiasis epi

young children

dentures

immune deficiency

Candidiasis pathophys

overgrowth of yeast

Candidiasis clinical presentation

sores in mouth, redness

Candidiasis PE findings

pseudomembranous = MC, white plaques

atrophic = erythematous, no plaques

Candidiasis dx

KOH (Potassium Hydroxide) test

clinical

Candidiasis tx

topical nystatin/clotrimazole

angular cheilitis pathophys

mechanical trauma or infection

angular cheilitis clincal presentation

sores along side of mouth

angular cheilitis dx

KOH prep

clinical

angular cheilitis tx

fix cause = hygiene

barriers due to infectivity

herpes simplex pathophys

herpes type I

herpes simplex epi

latency = triggers

herpes simplex clinical presentation

prodromal then lesions

herpes simplex PE findings

vesicular intraoral lesions

herpes simplex dx

Tzank smear, clinical

herpes simplex tx

pain control

antivirals + OTC meds

Apthous stomatitis pathophys

unknown

Apthous stomatitis epi

common in kids, decreases with age

Apthous stomatitis clinical presentation

painful oral lesions

Apthous stomatitis risk factors

genetics, trauma, sensitivities

Apthous stomatitis PE findings

round ulcers, grayish base

Apthous stomatitis tx

self-limiting, symptom management

coxsackie virus epi

usually kids

coxsackie virus clinical presentation

ulcers - mouth, feet, hands, buttock

coxsackie virus PE findings

oval papules

coxsackie virus dx

clinical

coxsackie virus tx

supportive

oral/throat cancer epi

MC elderly males; HPV

oral/throat cancer risk factors

tobacco + ETOH

oral/throat cancer clinical presentation

non healing sores

oral/throat cancer dx

biopsy, imaging

oral/throat cancer tx

multidisciplinary, radiation/surgery

leukoplakia pathophys

hyperplasia of squamous epithelium; trauma, chemical exposure, etc (pre-cancerous lesions)

leukoplakia risk factors

tobacco + ETOH

leukoplakia clinical presentation

hard spot; white patches

leukoplakia PE findings

leukopenia PE findings

leukopenia dx

biopsy

leukopenia tx

± retinoids

viral pharyngitis epi

very common, children and youth

viral pharyngitis pathophys

multiple = influenza, EBV

viral pharyngitis clinical presentation

sore throat, URI symptoms, ± fever

influenza = myalgias, cough

EPV = malaise, HA, then pharyngeal

viral pharyngitis dx

clinical = rapid tests, adenopathy (EBV = post cervical chain), ± labs

viral pharyngitis tx

symptoms, Tamiflu, steroids

viral pharyngitis complications

splenic rupture, hairy tongue leukoplakia

bacterial pharyngitis epi

very common

bacterial pharyngitis pathophys

strep is MC

bacterial pharyngitis clinical presentation

sore throat, tonsilar exudate, adenitis

bacterial pharyngitis differential dx

peritonsilar abscess, epiglottitis, ludwig angina

bacterial pharyngitis dx

centor criteria, cultures, labs = ASO titer?

bacterial pharyngitis tx

strep = PCN, Amox

bacterial pharyngitis complications

rheumatic fever, scarlet fever

pharyngeal disease centor criteria

tonsillar exudates

tender anterior cervical adenopathy

fever by hx

absence of cough

peritonsilar abscess epi

MC in young adults

peritonsilar abscess pathogen

from tonsilitis or pharyngitis

peritonsilar abscess clinical presentation

sore throat, unilateral, “hot potato” voice

peritonsilar abscess dx

PE exam = unilateral swelling, uvular deviation

labs = strep, ± CBC

imaging

peritonsilar abscess tx

I&D

Abx

peritonsilar abscess complications

airway compromise, aspiration pneumonia, sepsis

Xerostomia epi

older adults

Xerostomia pathophys

medications, chemo/radiation, autoimmune

Xerostomia clinical presentation

dry mouth, thick saliva, frequent infections

Xerostomia PE findings

dry, cobblestone tongue

tooth decay

check neuro exam

Xerostomia dx

antibodies = anti-RO(SS-A), anti-LA(SS-B)

RF (rheumatoid factor) and ANA (antinuclear antibodies)

whole sialometry

biopsy/imaging

Xerostomia tx

sialogogue, pilocarpine

Xerostomia complications

damage to teeth/gums, dysphagia