Oral disease Notes


Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Oral disease essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Oral disease:

Aphthous ulcers

Dental caries disease

Gingivitis and periodontitis

Ludwig angina

Oral candidiasis



NOTES NOTES ORAL DISEASE GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES ▪ Infectious, inflammatory diseases; affect oral cavity, associated structures RISK FACTORS ▪ Poor oral hygiene, dehydration, concomitant illness, malnutrition DIAGNOSIS DIAGNOSTIC IMAGING X-ray ▪ See individual diseases CT scan ▪ Soft tissue inflammation extension SIGNS & SYMPTOMS ▪ Inflammation ▫ Redness, swelling, pain, loss of function, warmth ▪ Infection ▫ Fever, malaise, localized pain TREATMENT MEDICATIONS ▪ Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain ▫ For inflammation ▪ Antibiotics, antifungal medications ▫ For infection APHTHOUS ULCERS osms.it/aphthous-ulcers PATHOLOGY & CAUSES ▪ Painful lesions inside mouth; benign, noninfectious; AKA canker sores TYPES Minor ▪ Small (3–4mm), last 7–10 days, recur 3–4 times/year; if recurrent, > 4 times/year Major ▪ Lesions > 1cm, last 10–30 days 334 OSMOSIS.ORG Herpetiform ▪ Coalesce, recur frequently CAUSES ▪ Idiopathic; likely multifactorial; may be part of TH1 autoimmune response, hormonal factors influence epithelium thickness, connected to vitamin B12 deficiencies RISK FACTORS ▪ Stress, systemic autoimmune disorders (e.g. celiac), nutritional deficiencies, stopping smoking, oral cavity trauma (e.g. biting lips, dentures)
Chapter 39 Oral Disease COMPLICATIONS ▪ Recurrent aphthous stomatitis (Mikulicz ulcers), infection; may interfere with eating/ drinking SIGNS & SYMPTOMS ▪ Round/oval ulcerations in oral mucosa, white/yellow sharply demarcated center covered with fibrous membrane cap, surrounded by red erythematous margins; yellowish exudate ▪ Inside of cheeks, lips; under tongue; painful swallowing, if in back of throat Minor ▪ Small, mildly painful, annoying, round/ oval, disappear within seven days, resolve spontaneously, no scarring; more common on non-keratinized epithelium DIAGNOSIS OTHER DIAGNOSTICS ▪ Recurrence of ulcers TREATMENT MEDICATIONS ▪ Vitamin B12 supplementation ▪ Topical analgesics, corticosteroids, sucralfate suspension ▪ Anti-tumor necrosis factor (TNF)-alpha agents ▫ Recalcitrant, recurrent ulcers OTHER INTERVENTIONS ▪ Avoid triggers Major ▪ Larger, painful, recur more often, may scar Herpetiform ▪ Not herpes virus connected, vesicles coalesce into patches Figure 39.1 The clinical appearance of aphthous ulcers. OSMOSIS.ORG 335
DENTAL CARIES DISEASE osms.it/dental-caries DIAGNOSIS PATHOLOGY & CAUSES ▪ Odontogenic infections; tooth decay caused by acids produced by bacteria. ▪ Bacteria → plaque → ↓ pH → demineralization → caries CAUSES ▪ Streptococcus mutans, Streptococcus sabrinus, Lactobacillus spp. ▫ Metabolically produce acids RISK FACTORS ▪ Prolonged bottle use (baby bottle tooth decay), poor oral hygiene, sugar-rich foods, diabetes mellitus (DM), salivary gland disorders (e.g. Sjogren’s), medications that decrease salivation COMPLICATIONS ▪ Hematogenous spread of bacteria to heart valves, joints, implanted prosthetics ▪ Spread from enamel to tooth pulp, alveolar bone ▪ Abscesses ▪ Soft tissue infections in extraoral perforation ▪ Deep head, neck infections ▪ Jaw osteomyelitis ▪ Tooth loss DIAGNOSTIC IMAGING Odontogram ( jaw X-ray) ▪ Examine depth of lesions CT scan ▪ If widespread, soft tissue infection OTHER DIAGNOSTICS Clinical presentation ▪ Teeth discoloration, changes TREATMENT MEDICATIONS ▪ Topical/systemic antibiotics SURGERY ▪ Extraction of infected material, replacement with fillings OTHER INTERVENTIONS ▪ Dietary counselling, hygiene improvement SIGNS & SYMPTOMS ▪ Yellow/black teeth staining, enamel softening; appearance of pits, cracks ▪ If severe: tooth collapse ▪ If pulp affected: dull pain exacerbated by cold, soft food ▪ If root caries: lower, where teeth close together, food difficult to extract; more difficult to diagnose 336 OSMOSIS.ORG Figure 39.2 A dental cavity in the tooth of a ten-year-old boy.
Chapter 39 Oral Disease Figure 39.3 An orthopantomogram demonstrating dental cavities of the left mandibular second and third molar teeth. GINGIVITIS osms.it/gingivitis PATHOLOGY & CAUSES ▪ Type of periodontal disease; inflammation of gums ▪ Pathogenic bacteria tunnel between microcolonies on tooth to surface in order to bring in steady supply of food → form hard mass (dental calculus) → bacterial plaque formation → enter gingival sulcus → gingivitis ▪ Immune response delivers blood to damaged tissue → provides nutrients for bacteria → immune response activates osteoclasts → dissolves bone → tooth loosening ▪ Non-infectious systemic factors → gingival overgrowth, inflammation ▫ Hormonal shifts (e.g. during pregnancy) ▫ Drug-induced (e.g. phenytoin, calcium channel blockers) ▫ Malnutrition-induced (e.g. vitamin C deficiency) ▫ Non-plaque-induced (rare, associated with genetics, allergy, trauma) COMPLICATIONS ▪ Periodontitis, tooth loss, receding gums SIGNS & SYMPTOMS ▪ Redness, swelling, bleeding after brushing/ flossing ▪ May be asymptomatic in early infection DIAGNOSIS DIAGNOSTIC IMAGING X-ray ▪ Evaluate bone level, sulcus becomes deeper as periodontal pocket expands OTHER DIAGNOSTICS Physical exam ▪ Swollen/bleeding gums, probe gingival sulcus to determine depth RISK FACTORS ▪ Poor dental hygiene, older age OSMOSIS.ORG 337
TREATMENT MEDICATIONS ▪ Antibiotics for severe infections SURGERY ▪ Removal of infected tissue if severe Figure 39.4 An individual with a severe case of gingivitis. The gums are swollen and hemorrhagic. There is visible plaque covering the free gingival margin of both maxillary incisors. LUDWIG'S ANGINA osms.it/ludwigs-angina PATHOLOGY & CAUSES ▪ Bilateral infection of submandibular space (sublingual, submylohoid) CAUSES ▪ Spread from infection of 2nd/3rd mandibular molars, pericoronitis, parotitis, peritonsillar abscess ▪ Mandibular fracture, piercings ▪ Causative agents polymicrobial from mouth flora, dominated by Streptococcus viridans; staphylococci, bacteroides also common RISK FACTORS ▪ DM, hypertension, HIV infection, immunosuppression COMPLICATIONS ▪ Airway obstruction, mediastinitis, necrotizing cellulitis, sepsis, asphyxia 338 OSMOSIS.ORG SIGNS & SYMPTOMS ▪ Infection ▫ Fever, chills, malaise, pain ▪ Stiff neck, dysphagia, individual leans forward to expand airway, no lymphadenopathy, bilateral, sudden aggressive spread, enlarged tongue, drooling ▪ Critical symptoms ▫ Stridor, cyanosis ▪ No abscess formation DIAGNOSIS DIAGNOSTIC IMAGING CT scan ▪ Rule out abscess formation (occurs late in disease) ▪ Chest CT scan ▫ Mediastinitis
Chapter 39 Oral Disease LAB RESULTS TREATMENT ▪ Blood culture MEDICATIONS OTHER DIAGNOSTICS ▪ Ultrasound-guided needle aspiration ▪ Empiric broad-spectrum antibiotics with beta-lactamase activity SURGERY ▪ Surgical drainage, if abscess identified on CT scan OTHER INTERVENTIONS Airway management ▪ Fiberoptic nasal intubation, emergent tracheostomy may be necessary ORAL CANDIDIASIS osms.it/oral-candidiasis PATHOLOGY & CAUSES ▪ Opportunistic infection of oral mucosal membranes by Candida spp. (e.g. Candida albicans) ▪ AKA thrush TYPES Pseudomembranous ▪ Whitish plaques on oral mucosa (most common); can be scraped off to reveal erythematous surface Atrophic (denture stomatitis) ▪ Red lesions without plaques Hyperplastic (rare) ▪ Non-scrapable plaques RISK FACTORS COMPLICATIONS ▪ Spread into pharynx, disseminated candidiasis SIGNS & SYMPTOMS ▪ ▪ ▪ ▪ ▪ ▪ May be asymptomatic Cottony feeling in mouth; lesions Pain/tenderness in oral cavity Painful swallowing (odynophagia) Decreased sense of taste Angular cheilitis DIAGNOSIS LAB RESULTS ▪ Microbiological analysis of scrapings; Gram stain; KOH preparation; biopsy ▪ Young age, dentures, xerostomia, antibiotics, DM, malnutrition ▪ Immunosuppression due to corticosteroids, chemotherapy, HIV/AIDS OSMOSIS.ORG 339
TREATMENT MEDICATIONS ▪ Topical antifungal agents (e.g. nystatin suspension, clotrimazole troches, systemic fluconazole) Figure 39.5 Oral candidiasis in a child who had taken antibiotics. PAROTITIS osms.it/parotitis PATHOLOGY & CAUSES ▪ Parotid gland inflammation ▪ Salivary stasis → seeding of parotid (Stensen) duct by microorganisms → infection, inflammation CAUSES ▪ Bacterial: S. aureus, most common ▪ Viral: mumps, influenza, coxsackie, Epstein– Barr virus (EBV) ▪ Autoinflammatory: sarcoidosis as part of Mikulicz syndrome RISK FACTORS ▪ Surgery, dehydration, salivary gland stones, poor oral hygiene, medications that decrease salivation (e.g. anticholinergic, 340 OSMOSIS.ORG sympathomimetics) COMPLICATIONS ▪ Spread to deep head, neck structures; septic jugular thrombophlebitis; septic osteomyelitis; sepsis; respiratory obstruction; facial nerve palsy SIGNS & SYMPTOMS ▪ Systemic manifestations ▫ Fever, chills ▪ Periauricular, mandibular pain, swelling; trismus, dysphagia; purulent drainage ▪ Viral ▫ No discharge, prodrome followed by swelling lasting 5–10 days
Chapter 39 Oral Disease DIAGNOSIS DIAGNOSTIC IMAGING ▪ Sample purulent exudate, ultrasound guided needle aspiration; culture, Gram stain Ultrasound ▪ Increased blood flow through gland, enlargement, nodules CT scan ▪ Extension of inflammation to surrounding tissues LAB RESULTS ▪ Complete blood count (CBC) ▪ Increased amylase without underlying pancreatitis ▪ Viral shows leukocytosis, increased IgM against mumps Figure 39.6 The clinical appearance of parotitis of the left parotid gland. There is a marked swelling just anterior to the left ear. TREATMENT MEDICATIONS ▪ Hydration; IV antibiotics ▪ Vaccination ▫ Mumps prevention PERIODONTITIS osms.it/periodontitis PATHOLOGY & CAUSES ▪ Inflammation, destruction of supporting structures around teeth, wasting of bone ▪ Dysbiosis (disturbed bacterial symbiosis) more extreme than in gingivitis ▪ Orange-complex of bacteria (Fusobacterium nucleatum, Prevotella intermedia), red-complex of bacteria (Tannerella forsythia, Treponema denticola, Porphyromonas gingivalis) → immune response → more blood flow to damaged tissue → provides nutrients for bacteria → more damage to gingiva, periodontal ligament → activated osteoclasts in bone → tooth loosening ▪ Severity based on ligament loss ▪ Porphyromonas gingivalis impairs immune cells, kills bacteria → pathogenic bacteria overgrow ▪ Necrotizing ulcerative periodontitis (NUP) ▫ Extreme loss of periodontal attachment, alveolar bone; associated with immunosuppression (e.g. HIV/AIDS; chemotherapy, severe malnutrition); may be associated with enteric bacteria, yeast OSMOSIS.ORG 341
CAUSES ▪ Poor oral hygiene; red-, orange-complex bacteria RISK FACTORS OTHER DIAGNOSTICS ▪ Clinical exam ▫ Probe teeth pockets, test for bleeding, depth TREATMENT ▪ DM, smoking, Ehler–Danlos syndrome COMPLICATIONS ▪ Tooth loss, infection spread to soft tissues of head, neck, sinusitis; hematogenous dissemination to heart valves (prosthetic/ native), joints, etc. SIGNS & SYMPTOMS ▪ ▪ ▪ ▪ ▪ Redness, swelling, tender to palpation Halitosis Bleeding during teeth brushing Teeth loosening Periodontal pockets widen MEDICATIONS ▪ Systemic antibiotics (if severe) SURGERY ▪ Removal of infected tissue (if severe) OTHER INTERVENTIONS ▪ Prevent plaque formation ▫ Daily brushing, flossing; antimicrobial agents (e.g. mouthwash) ▪ Scaling, root planing ▫ Remove plaque ▪ Topical fluoride DIAGNOSIS DIAGNOSTIC IMAGING Panoramic dental X-ray ▪ Bone loss around tooth SIALADENITIS osms.it/sialadenitis PATHOLOGY & CAUSES ▪ Inflammation of salivary glands ▫ Parotid (most common), sublingual, submandibular; unilateral ▪ Decreased flow of saliva → deposits settle in walls of salivary duct → duct blocked → flow of saliva slowed → deposits of calcium, phosphorous, etc. precipitate → form small concretions (microsialoliths) → grow into sialoliths → stones block duct → bacteria moves from mouth up, around blockage, into salivary duct → 342 OSMOSIS.ORG inflammation, tissue swelling CAUSES ▪ Bacterial: Staphylococcus aureus (most common), Streptococcus viridans, Haemophilus influenzae ▪ Viral: mumps, HIV RISK FACTORS ▪ Decreased salivary flow (dehydration, illness, anticholinergic medications, Sjogren’s syndrome) ▪ Risk increases with age
Chapter 39 Oral Disease LAB RESULTS ▪ Lab culture of pus ▫ Gentle compression of gland OTHER DIAGNOSTICS ▪ Clinical presentation TREATMENT MEDICATIONS ▪ Antibiotics SURGERY Figure 39.7 An individual holding their own salivary duct stone following surgical removal. Salivary duct stones predispose individuals to sialadenitis. ▪ Surgical gland removal ▫ If disease recurrent OTHER INTERVENTIONS ▪ Hydration, warm compress, glandular massage, sialogogues SIGNS & SYMPTOMS ▪ Acute sialadenitis ▫ Fever, chills, abscess formation ▫ Pain, swelling, redness of skin overlying affected gland ▫ Less saliva → dry mouth → bad taste (pus leaking out of affected duct) ▫ Severe: painful to open mouth ▪ Chronic sialadenitis ▫ Less painful, gland enlarges following meals, no overlying redness of the skin ▫ Associated with conditions linked to chronic decreased salivary flow (e.g. Sjogren’s syndrome), due to inflammation, salivary duct fibrosis, altering glandular tissue, composition of saliva DIAGNOSIS Figure 39.8 A submandibular sialogram demonstrating a salivary duct stone; a risk factor for sialadenitis. DIAGNOSTIC IMAGING Ultrasound ▪ Abscess, salivary stone, tumor OSMOSIS.ORG 343
Figure 39.9 The histological appearance of sialadenitis at low power. The acini are surrounded by dense fibrosis and display patchy lymphocytic infiltrates. 344 OSMOSIS.ORG

Osmosis High-Yield Notes

This Osmosis High-Yield Note provides an overview of Oral disease essentials. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Find more information about Oral disease by visiting the associated Learn Page.