Oral Medicine

CELLULITIS

"Inflammation of the cellular tissue." -Caused by a bacterial infection. -A nonvital tooth is usually the root of the problem.

DRUG INDUCED GINGIVAL HYPERPLASIA (DILANTIN)

-25 to 50% of patients taking phenytoin (Dilantin), experience gingival hyperplasia. -Within time, the gingiva has the potential to totally encapsulate the dentition.

Ranula

-A large mucin-continuing cyst located in the floor of the mouth. -It forms as a result of inhibition of normal salivary flow, which accumulates in the salivary duct.

ACUTE NECROTIZINC ULCERATIVE GINGIVITIS (ANUG)

-Acute gingivitis linked to specific bacterial species and stress. -Also known as, "Vincent's Infection" or "Trench Mouth". -High population of fusiform bacillae and spirochetes. ANUG -characterized by fever,malaise, fiery red gingiva, hypersalivation, and unmistakable bad breath.

THRUSH

-Acute pseudomembranous candidiasis is a fungal infection that is caused by candida albicans. -Appears milky white, easily wiped off, leaving a red, raw, painful surface. -Newborns often acquire the infection from the mothers' birth canal during delivery.

STEVENS JOHNSON SYNDROME

-Advanced case of EM. -Classic clinical triad consists of eye lesions (conjunctivitis), genital lesions and stomatitis. -Extensive ulcerative and hemorrhagic lesions of the lips and oral mucosa. -Affects patients eating and swallowing.

PREGNANCY GINGIVITIS

-Although alterations in estrogen/progesterone levels as a result of hormonal shifts are documented, the exact causative mechanism remains unknown. -Recommended that a pregnant patient visits her dentist during each trimester for an exam/prophy.

APTHOUS ULCER (CANKER SORE)

-Approximately 20% of the population are afflicted with "canker sores". -Females and young adults are more susceptible. -Persons who smoke are less likely to be affected. -Factors that might precipitate apthae include: trauma, menstruation, nutritional deficiencies, stress, food allergies. -Usually heal spontaneously without scar formation within 14 days.

ADDISONS DISEASE

-Autoimmune induced destruction of the adrenal gland. -Progression of the disease results in anemia, anorexia, diarrhea, hypertension, lethargy, and nausea. -Failure of the feedback loop from the adrenal gland causes increase in (ACTH) which induces melanocyte stimulating hormone and the deposition of melanin in the skin. -Skin acquires a bronze tan. -Replacement therapy with corticosteroid. -Pigmentation on the gingiva gives a good model to see if treatment is working.

TORUS, EXOSTOSIS AND OSTEOMA

-Bony protuberances of the jaws, localized to the palatal midline or mandibular lingual attached gingiva, are termed "Tori". -Females are most frequently affected. -Tori and exostisis increase slowly in size with increase in age. -Removal is generally unnecessary. -Not, pre-cancerous.

LUPUS

-Butterfly lesions -Red lesions must be biopsied in oral cavity

Snuff Dippers Patch Tx

-Cessation of use is recommended -Biopsy is necessary if area is not clear within fourteen (14) days of cessation

INFECTIOUS MONONUCLEOSIS

-Characterized by fatigue, fever, malaise, pharyngitis, stomatitis and occasional jaundice. -Caused by the Epstein Barr Virus. -Transmission is thought to be from virus contaminated saliva ("The Kissing Disease"). -Multiple red petechiae located at the junction of the hard and soft palate.

Varicella (chickenpox)

-Chickenpox and shingles are caused by the same herpetic virus, Varicella Zoster. -Varicella is the highly contagious primary infection. -The first and largest skin lesion is called the "Herald Spot" and may scar if scratched

PARULIS (GUM BOIL)

-Chronic bacterial infection of a non-vital tooth, spontaneous pain is usually not present. -Elimination of the infection leads to resolution.

ANGULAR CHEILITIS

-Chronic, bilateral and often associated with denture stomatitis or glossitis. -Predisposing conditions include, anemia, poor oral hygiene, and vitamin B group deficiency.

LEUKOPLAKIA

-Clinical term descriptive of white plaque or patch on the Oral mucosa that cannot be scraped off. -Leukoplakia are protective reactions against chronic irritants. -Leukoplakias with localized red areas confer a high risk of carcinoma

LINEA ALBA

-Common finding; raised wavy line 1-2 mm wide extends from the canine to 2nd molar.

VERUCA VULGARIS

-Common skin growth that seldom occurs intraorally. -Surface is rough and raised. -Located on the skin or vermilion border.

INCISIVE CANAL CYST

-Developmental cyst forms from entrapped squamous or respiratory epithelial remnants. -May occur at any age, anywhere along the incisive canal.

SNUFF DIPPERS PATCH

-Early snuff dippers patches are pale pink in color, with the surface appearing corrugated and wrinkled. -A progression to white, yellow-white, yellow-brown staining will occur over time. -Chronic smokeless tobacco use is associated with periodontal alterations, caries, epidermal dysplastic changes, and verrucous carcinoma.

PALATAL TORI

-Effects approximately 20% of the population. -It is a bony exostosis, frequently inherited, frequently asymptomatic unless traumatized.

ENAMEL HYPOPLASIA

-Enamel that is decreased or removed is Termed Hypoplastic -Variety of influences including, genetic (Ameleogenisis Imperfecta), local factors (trauma), systemic factors (flourosis). -Flourosis is addition of excessive fluoride

HEAVY METAL PIGMENTATION

-Excessive ingestion of heavy metals (bismuth, lead, mercury, silver) can produce mucocutaneous pigmentation. -Bismuth commonly found in diarrhea medications, if used chronically would result in defuse deposition of metal in the gingiva. -Lead poisoning; exposure to excessive doses of led used in paints or plumbing. -A gray/black "Lead Line" occurs on the gingiva. -Mercury poisoning; acquired by absorption, inhalation, ingestion. -Uncommon today, mercury was once used in treatment of Tertiary Syphilis. -Silver pigmentation is rare but occurs with prolonged exposure to ocular or nasal medications. -Condition is irreversible.

BULIMIA/ANOREXIA Tx

-Fluoride treatments for early erosions and restorative needs met -Habit elimination or behavior modification is required for success. -Treatment consists of topical fluoride for early erosions. -For more extensive damage, restorations are needed.

GINGIVAL CARCINOMA

-Gingiva carcinoma accounts for 5 to 10% of all cases of squamous cell carcinoma. -Asymptomatic and usually in the posterior. Appears as a red/white lesion.

SEXUALLY TRANSMITTED PHARYNGITIS (HERPES II)

-HSV II: caused by direct transmission from contact with infected genital or oral secretions. -Symptoms include pharyngotonsillitis (sore throat), fever. -The vesicles collapse to form ulcers that resolve in 10 to 21 days.

BULIMIA/ANOREXIA

-Have profound effects on the dentition, and is a way of making a diagnosis. -Erosion of the lingual surfaces of the maxillary teeth resulting from chronic regurgitation due to bulimia.

AMELOGENESIS IMPERFECTA

-Heredity disorder resulting in the malformation of enamel. -Without the existence of enamel patients become extremely susceptible to decay.

HERPETIC GINGIVOSTOMATITIS

-Herpes Simplex Virus (HSV) Type 1. -Included; Cytomegalovirus, Varicella Zoster, Epstein Barr. -Approximately 80 to 90% of human population have been infected with HSV. -HSV has incubation period of 3 to 10 days lasts 12 to 20 days. -Is a highly contagious disease

GINGIVITIS

-Inflammation of the gingiva, is related to a bacterial infection. -Initially gram + organisms. -Gingivitis can occur at any age. But mostly arises during adolescence. -Different types of gingivitis: actinomycotic, diabetic, hormonal, leukemic, plasma cell, HIV. -Gingivitis most often is chronic and non-painful.

HEREDITY HEMORRHAGIC TELANGIECTASIA

-Is a genetic disease, Multiple telangiectasias, which represent permanently enlarged capillaries. -Sometimes may rupture, not often.

PERIPHERAL GIANT CELL GRANULOMA

-Is a reactive epulis like growth on the gingiva that is usually associated with a history of trauma or irritation. -It is thought to arise from the periodontal ligament.

DENTAL LAMINA CYSTS

-Keratin filled cysts, appear as pearls. -Resolution happens with normal tooth eruption

HEMATOMA

-Large pools of blood. -Occurs most commonly in the oral cavity due to a blow in the face. -They fade with time.

LEUKEMIC GINGIVITIS

-Leukemia, a malignant condition characterized by white blood cell overproduction. -Oral manifestations are more frequently encountered in acute leukemia. -Leukemic gingival tissues are usually red, tender, spongy, and tend to peel away from the teeth. -Gingival hemorrhaging occurs frequently.

LINGUAL VARICOSITY

-Lingual varicosities are a common finding in elderly adults. -Etiology of these vascular dilations is either a blockage of the vein or a loss of elasticity of the vascular wall. -Lesions are asymptomatic - no treatment required.

STUGE - WEBER SYNDROME

-Macular hemangioma of the facial skin, also termed ("Port-Wine Stain"). Most striking feature of the syndrome -Calcification inside skull called "tram lines", 30 % have ocular abnormalities. -this lesion stops at the midline. -Tendencies to bleed heavy in area of pigmentation

SQUAMOUS CELL CARCINOMA

-Malignant neoplasm of mucosal origin. -Most common oral cancer accounting for 90% of malignant neoplasms. -Excessive use of alcohol and tobacco together increase susceptibility to squamous cell carcinoma. -The prognosis of oral cancer depends in large part on the site involved. -The clinical stage and width of tumor. -Early treatment is paramount. -Prognosis is good if caught early.

MALIGNANT MELANOMA

-Malignant neoplasms of melanocytes. -Two times more frequent in males. -30% of melanomas have been reported to arise from previously pigmented lesions and have very rapid growth. -Multiple colors, ill defined margins. -Extremely dangerous and very poor prognosis.

HAND-FOOT-AND-MOUTH DISEASE

-Mildly contagious; caused by the Coxsackie Virus. -Occurs in spring and summer months. -Oral lesions of the Hand-Foot-Mouth disease are scattered mainly on the tongue, hard palate, buccal and labial mucosa. -Healing occurs regardless of treatment in approximately 10 days.

MUCOCELE

-Most common nodular swelling of the lower lip. -Asymptomatic, soft, fluctuant, bluish gray. -Children and young adults mostly affected. -Trauma is the etiologic agent.

WHITE SPONGE NEVUS

-Occurs at birth and persists throughout life -Mucosal lesions that are asymptomatic, white, folded, and spongy - location buccal mucosa

CARIES (CAVITIES)

-One of the most common bacterial infections of man. -Primary pathogen is Streptococcus Mutans. -Produces lactic acid necessary for the destruction of enamel. - "Nursing bottle caries" - is the prolonged contact of teeth with sugar containing liquids in infants

PAPILLOMA

-Papillomas are the most common benign epithelial neoplasm of the oral cavity. -HPV is the viral etiology. -The most common location is the Uvulopalatal Complex, followed by the tongue, frenum, lips.

ERYTHROPLAKIA

-Persistent velvety red patch. -Diagnosed as Epithelian Dysplasia (change in cellular structure) and thus have a higher occurrence for progression to carcinoma.

NATAL TEETH

-Predeciduous teeth with little or no root formation, mobility is a common feature. -Determination of an erupting primary tooth should be made before extraction.

HERPES ZOSTER (SHINGLE)

-Recurrent infection of chickenpox. -Older people effected. -Travels along the ophthalmic division of the Trigeminal nerve. -Heals within 3 weeks but some patients have "Postherpetic Neuralgia" for months

AMALGAM TATOOS

-Restorative material used in fillings. -If introduced beneath the gingiva can cause a tattoo like area

Erythema Multiforme

-Self limiting disease of the skin and mucous membrane. -Commonly effects young adults. -Unknown etiology. -Pain is the most common symptoms.

HERPANGINA

-Self-limiting infection involving the oral cavity caused by Coxsackie Virus. -Mainly in children in summer months and is highly contagious. -Symptoms include; fever, malaise, headache, lymphadenitis, abdominal pain, vomiting.

CONGENITAL EPULIS OF THE NEWBORN

-Soft tissue growth arising from the gingiva of the edentulous alveolar ridge of newborn infants. -Usually occurs in the anterior maxilla and is ten times more frequent in females.

OSTEOGENISIS IMPERFECTA/DENTNOGENISIS IMPERFECTA

-Systemic condition involving bone fragility, blue sclera. -Teeth are extremely fragile and usually fracture.

Leukemic Gingivitis Tx

-Systemic control of leukemia often involves radiotherapy, chemotherapy, blood transfusions, and bone marrow transplants. -Difficulty is encountered keeping these patients orally healthy due to the chemotherapy induced oral lesions. -Treatment consists of meticulous oral hygiene and antimicrobial rinses.

CONDYLOMA ACUMINATUM (Venereal Warts)

-Transmissible papillomatous growth that looks similar to the papilloma. -Usually multiple lesions, resembles a cauliflower. -Contagious spread can occur among the host and sexual partners. -Wide excision because they have a high recurrence rate.

Tx of PERIPHERAL GIANT CELL GRANULOMA

-Treatment consists of surgical excision and debridement. -Failure to remove cells results in a marked tendency for recurrence.

Papilloma Tx

-Treatment is complete excision. -Recurrence is rare. -No documented cases of malignant transformation

INFECTIOUS MONONUCLEOSIS Tx

-Treatment is supportive, bed rest. -Recovery 1 to 2 months.

SYPHILIS

-Venereal disease caused by an anaerobic spirochete (Treponema Pallidum). -Hallmark of primary syphilis is non-painful chancre. Lips are the most common site. -Chancres typically persists for 2 to 4 weeks and heals spontaneously. -Highly contagious. -Latent period of 4 to 6 weeks. -Second stage consists of headaches, lacrimation, nasal discharge, sore throat, elevated temperature and weight loss. -Oral lesions occur as oval red macules, borders are irregular and often resemble "Snail Tracks". -Tertiary Syphilis occurs in infected persons many years later. -Possible palatal perforation and neurologic symptoms.

VERRUCOUS CARCINOMA

-Warty, exophytic, cauliflower -like whitish mass. -Is considered low-grade and nonmetastasizing. -Males over 60 most often affected.

NICOTINE STOMATITIS (PIPE SMOKERS PALATE)

-a response of the palatal structures to prolonged pipe/cigar smoking. -Initially the irritation causes the palate to become erythematous, the areas enlarge as the irritation persists. -Whether the lesion arises as a consequence of heat or of tobacco is a matter of debate. -Reverse cigarette smoking produces similar findings. -Discontinuation of smoking usually results in regression

Verrucous Carcinoma tx

-surgical excision -radiation therapy is contraindicated

PERIODONTAL ABSCESS

A fluctuant swelling of the gingiva resulting from bacteria entering the gingival crevice. .

Common Prescriptions for Oral Infections

Abx: -Amox -Clindamycin (if pen allergy) Analgesics: -Ibuprofen -oxycodone Antifungal- Nystantin Antiviral- Acyclovir Ointment

TRAUMATIC SWELLING Treatment

Apply ice; limit the traumatic influence treat lacerations.

PLEOMORPHIC ADENOMA

Benign accessory salivary gland tumor. Appears purple in color.

MELANOTIL NEUROECTODERMAL TUMUR OF INFANCY

Benign, rapidly growing neuroblastic neoplasm located in anterior maxilla

FUSION

Developmental disturbance during tooth formation resulting in the "fusion of two tooth buds".

FORDYCE GRANULES

Ectopic sebaceous glands

NASOLABIAL CYST Tx

Excision

Tx of MELANOTIL NEUROECTODERMAL TUMUR OF INFANCY

Excision

HIV

HIV positive patients are very susceptible to bacterial infections, fungal infections, HIV periodontitis, HIV gingivitis

Tx of Cellulitis

Intense antibiotic therapy.

KAPOSIS SARCOMA

Is the most common malignancy associated with HIV infection

NASOLABIAL CYST

Mass under the lip, may cause elevation of the upper lip.

PALATAL TORI Tx

Palatal tori should be removed if they interfere with phonetics, mastication or construction of a prosthetic appliance.

PURPURA

Pooling of extravaseted blood

MUCOCELE

Retention of mucous fluid in subepithelial tissue usually results from trauma.

SALIVARY CALCULI (SIALOLITHS)

Salivary calculi or stones are secretions of calcium within a salivary gland or duct that obstructs salivary flow

DIABETIC GINGIVITIS

Severity of diabetic gingivitis depends on the stage of the disease and the patient's oral hygiene

LICHEN PLANUS

Stress related skin disease, can be painful

Tx of DRUG INDUCED GINGIVAL HYPERPLASIA (DILANTIN)

The gingiva usually does not regress with reduction of dosage; therefore excess tissue requires surgical removal.

Thrush Tx

Treatment consists of antifungal agents - applied topically

STEVENS JOHNSON SYNDROME Tx

Treatment consists of: -intravenous fluids and nutritional therapy -corticosteroids -oral anesthetic rinses -antiseptic mouth-rinses -Resolves within 6 weeks.

Gingitivis Tx

Treatment for acute and chronic forms of gingivitis consists of removal of dental plaque followed by daily oral hygiene measures.

Tx of CONGENITAL EPULIS OF THE NEWBORN

Treatment is complete excision and recurrence is unlikely

VERUCA VULGARIS Tx

Treatment is excision with carbon dioxide laser.

Ranula Tx

Treatment is excision. Recurrences are common.

Gingival Carcinoma Tx

Treatment is surgery/ radiotherapy

PLEOMORPHIC ADENOMA Tx

Treatment is surgical excision - recurrence is possible

Tx of ACUTE NECROTIZINC ULCERATIVE GINGIVITIS (ANUG)

Treatment requires irrigation, gentle debridement, antibiotics and stress reduction.

Syphilis Tx

Treatment with Pen G is recommended for all stages.

ANGULAR CHEILITIS Tx

Treatment with antifungal, vitamin supplementation

Periodontal Abscess Tx

Treatments consist of debridement and antibiotic therapy

Tx of Herpangina

palliative