HEENT - oral cavity (IP)

Common small, painful, round ulcerations of the buccal or labial mucosa with yellow/gray center and erythematous halo

Aphthous ulcers

Hypothesized causes of aphthous ulcers?

- herpes virus

- toothbrushes

- acidic foods

- toothpaste chemicals

- vitamin deficiencies

- stress

Viral etiologies of aphthous ulcers?

- herpes

- CMV

- Varicella

- Coxsackie

Acute febrile illness associated with small vesicular or ulcerative lesions of the posterior oropharynx

Herpangina

Differentiation between HFMD and herpangina?

Rash of herpangina is restricted to the mouth

If aphthous ulcers are large and persistent think of:

- drug allergies, EM, pemhigus/pemphigoid, celiac disease, IBD and SCC

Tx for aphthous ulcers?

- corticosteroids (triamcinolone + orabase or clobetasol)

- Peridex

- Topical benzocaine

- avoid soda/acidic food + toothpaste

Which virus causes herpetic gingivostomatitis?

HSV 1 and 2

What can trigger an outbreak of herpetic gingivostomatitis?

- immunosuppression

- trauma

- fever

- stress

Painful lesions most commonly on the gingiva and mucocutaneous junction of the lip (oral mucosa, tongue, soft palate) with fever, drooling, headache and cervical lymphadenopathy

Herpetic gingivostomatitis

Tx of herpetic stomatitis?

- self-limiting process

- analgesics - tylenol/ibuprofen

- hydration

- Acyclovir (immune compromised)

- viscous lidocaine

Which type of white patch on a tongue can easily be rubbed off?

Oral candidiasis

Which type of white patch on a tongue is painful?

Oral candidiasis

Lab studies for candidiaisis?

- KOH prep

- spores and non-septate mycelia

- biopsy reveals pseudohyphae

Risk factors for oral candidiasis?

- dentures

- poor oral hygiene

- anemia

- DM, chemo, abx use, HIV infection

Tx for candidiasis?

- infants: self limiting or nystatin suspension

- adults: ketoconazole, fluconazole, clotrimazole troches

- HIV: fluconazole - longer course, itraconazole

Causes of leukoplakia?

- chronic irritation, dentures, tobacco, and lichen planus

- 2-6% dysplasia and SCC

Erythroplakia is similar to leukoplakia but has ___

a definite erythematous component

90% of ___ are either dysplastic or SCC

Erythroplakia

Which type of white patch on the tongue is usually on the lateral surface?

Hairy leukoplakia

Hairy leukoplakia is associated with ___

EBV

Hairy leukoplakia exclusively occurs in patients that are ___ with HIV/AIDS or following organ transplant

immunocompromised

Is hairy leukoplakia painful?

no

3 multiple choice options

Which type of white patch does not predispose you to oral cancer?

thrush and hairy leukoplakia

Mutation of what gene predisposes you to Puetz-Jeghers

STK11

Puetz-Jeghers increases your risk of ___

GI, breast, and ovarian cancers

Light brown mucocutaneous pigmented spots along the vermillion border, labial and buccal mucosa which develop in childhood

Puetz-Jeghers

Oral hyperpigmentation is likely due to ___

Addison disease

Fatigue, hypotension, weight loss/GIs symptoms, bronzing of the skin and oral mucosa changes

Addison disease

Hyperpigmentation occurs b/c ACTH and ___ share a precursor molecule which causes melanocytes to overproduce melanin

MSH

Cortisol less than ___ confirms diagnosis of addison disease

20

Inflammation of the tongue with loss of filliform papillae with smooth red tongue and non-painful

Glossitis

Causes of glossitis:

- nutritional deficiencies (niacin, riboflavin, iron, vit E)

- drug reactions

- autoimmune reactions

- dehydration

- irritants

Glossodynia can present with or without ___

glossitis

Glossodynia without glossitis is known as "___"

burning mouth syndrome

Tx of glossodynia w/o glossitis?

- clonazepam

- stop smoking

Risk factors for Glossodynia with glossitis?

- DM

- smoking

- medications (dieuretics)

- dry mouth

- candidiasis

Most commonly affected glands of bacterial sialadenitis?

parotid and submandibular gland

Acute pain and swelling of the gland, swelling and postprandial pain, tenderness and erythema, pus from ducts, and fever/chills

Bacterial sialadenitis

What is associated with bacterial sialadenitis?

- dehydration

- sjogrens

- sarcoidosis