CM1 - Pathology of the mouth

If swelling of a dental abscess extends beyond local areas, what do we do?

CT maxillofacial bones, CBC, inflammatory markers

How do we manage dental abscesses?

I&D and endodontic therapy, antibiotics (PenVK and augmentin), analgesia (PO and local anesthesia)

For an oral lesion of > 3 weeks duration, how can we predict erythroplakia early?

RULE - red/red and white lesion, ulcer, lump, especially when in combination or if indurated

If erythroplakia is suspected:

always biopsy since 90% of cases are dysplasia or carcinoma

Etiology of sialadenitis:

bacterial MC, viral (mumps, HIV), obstructive

Hallmark of oral candidiasis:

can easily remove by scraping/rubbing, and then we see red, irritated mucosa

How do we work up a dental abscess?

clinical diagnosis, dental radiographs

How do we diagnose oral candidiasis?

clinically, can do KOH prep

How does oral candidiasis present?

creamy-white, curd-like patches on mucosa

How do we work up sialadenitis?

culture and sensitivity of ductal exudate, CBC, BMP, viral swabs as indicated, imaging (CT if severe clinical presentation)

How do we treat parotitis?

engage salivary flow, warm compresses, massages, sialagogues, IV hydration, oral abx 7-10 days

How do we treat sialadenitis?

engage salivary flow, warm compresses, sialagogues, NSAIDs, oral antibiotics (augmentin/clindamycin) if infected

Erythroplakia presentation:

fiery red, sharply demarcated patch most commonly located on the floor of the mouth, the ventral tongue, or soft palate

Sialolithiasis

formation of salivary gland stones in salivary glands or their ducts

How do we treat burning mouth syndrome?

gabapentin, amytriptaline; avoid tobacco and spicy/minty products, suck on crushed ice

Treatment of oral candidiasis:

good oral hygiene, mouth rinse after using PO steroids, also can use topical antifungal medications (nystatin, clotrimazole)

Oral candidiasis pathophysiology

host's immunity becomes disrupted, overgrowth of fungus, formation of a pseudomembrane

Pericoronitis

infection of gum that overlies partially erupted 3rd molar, can abscess

Glossitis

inflammation of the tongue characterized by swelling, changes in color or texture, and sometimes pain or difficulty with function

Sialadenitis

inflammation or infection of a salivary gland, usually caused by bacterial obstruction or decreased salivary flow

Burning mouth syndrome

intraoral burning sensation for which no medical or dental cause can be found, common in females

Periodontal abscess

involves supporting structures of teeth, more common in adults

Dental abscess

localized collection of pus arising from bacterial infection of the tooth

Dental abscess signs and symptoms:

localized, throbbing tooth pain, tenderness to percussion/chewing, thermal sensitivity, gingival swelling/fluctuance, and others...

In burning mouth syndrome, how does oral mucosa appear?

normal

What causes parotitis?

obstruction of the stensen duct via infection

Periapical abscess

originates in dental pulp, due to caries, more common in children

Signs and symptoms of oral candidiasis:

painful, multiple white patches on the tongue, palate, or other mucosal surfaces

Criteria for dx of burning mouth syndrome:

recurring daily for more than two hours per day for greater than three months, pain must be burning and felt superficially in oral mucosa

How does glossitis present?

red, smooth, shiny, swollen tongue; loss of papillae, pain, tenderness, burning, altered taste, difficulty swallowing chewing and speaking

What infections can cause obstruction of parotits?

staph aureus, mumps, foreign body obstruction

How do we treat erythroplakia?

surgical excision with clear borders, CO2 laser treatment

Sialadenitis signs and symptoms:

swollen, indurated, tender gland, massage of the gland yields purulent saliva at ductal orifice, obstruction visible

If a patient with oral candidiasis is immunocompromised, how do we treat?

systemic antifungals (fluconazole, ketoconazole)

Risk factors for oral leukoplakia:

tobacco, lichen planus, dentures

Pharmacologic ways to treat canker sores:

topical corticosteroids, chlorhexidine mouthwash, prednisone, NSAIDs

How do we treat glossitis?

treat underlying causes, good oral hygiene

Bacterial parotitis usually presents ____________, while viral parotitis usually presents _______________.

unilaterally, unilaterally then bilaterally

How do we treat oral leukoplakia?

we don't

Oral leukoplakia

white plaque lesion that cannot be removed by rubbing the mucosal surface