Periodontium

-definition

-4 main parts

Supporting Tissue of the tooth

-gingiva

-periodontal ligament

-cementum

-alveolar bone

1-Gingiva-what is it and two parts

2-Black, hispanic and Asian Gingiva (gums)

1-Gums=(attached Gingiva)and(alveolar mucosa)

2-Can appear darker than Caucasian Gingiva

Inflamm. of the Gingiva (gums)

-limited to gingival tissue only, completely reversible (no lose of structural support)

Peridex, Rx

-spread of the inflamm. process from the gingiva to the supporting periodontal tissues

-bone moves away from the crown of the tooth

-non-reversible

Sx:

-chronic inflamm. of gingiva

-Pocket formation

-Bone loss

-tooth mobility

-Pathological migration of teeth

Tooth anatomy, superficial to deep (also the order of Caries)

(Caries are infectious and communicable)

Enamel, Dentin, Pulp-(vessels and nerves)

Crown-visible tooth Root-not visible

-associated w/ a non-vital tooth

-accumulation of inflammatory cells at the apex of the tooth (apex-point of root)

-cellulitis

If the abscess is not able to drain through the skin or oral cavity it will spread through the fascial planes of the soft tissue

-Tissue becomes hard and warm

Cellulitis/Periapical Abscess

-2 eg's

-treatment

1-Ludwig's Angina-involves sublingual, submandibular and submental fascial spaces

(difficulty breathing, true emergency)

2-Cavernous sinus thrombosis- Periorbital edema w/ eylid and conjonctiva involvement (infection can spread to brain=death, true emergency)

Treatment

-Maintenance of the airway

-I&D

-Antibiotic Therapy (PCN antibiotic of choice)

-Inflammed lesion develps around a partially erupted tooth (common w/ wisdom teeth-mandibular third molar)

-Painful, associated with a foul taste

-Treatment-peridex or saline lavage under flap of gingiva, antibiotics if fever is present, extraction of tooth.

Post Surgical Complications

2

Dry socket-delayed healing, no infection(no fever, swelling, or redness) Socket is empty (lose of clot) dull ache w/ radiating pain to ear. treat w/ saline irrigation then insert a strip of iodoform gauze soaked in eugenol, leave in for two days.

Subperiosteal infection-delayed healing w/ infection fever over 100 degrees, swelling around healing socket (socket is mostly closed) occurs 1-2 months after extraction. Treatment-refer to OS

Oral lesions

5 groups

Traumatic (eg-Morsicatio Buccarum)

Bacterial (eg-syphilis, TB)

Fungal (eg-Candidiasis)

Viral (eg-Herpes)

Unknown (Apthous Ulcers)

Traumatic oral Lesions

-give 3 eg's

Linea alba

-white line on buccal mucosa along line of occlusion(where teeth meet)

-very common, maybe from sucking buccal mucosa in

Morsicatio Buccarum

Bilateral on anterior buccal mucosa, common w/ stress

Traumatic Ulcer

red ulcer on buccal mucosa, tonue, lips w/ hyperkeratotic white ring.

-prob may be broken teeth, stress etc.

-common in men, typically found in mandibular vestibule, leathery, wrinkled, white apperance (no pain, no ulceration)

Treatment-make them quite and follow up in 6 weeks

Primary syphilis chancre, oral cavity is most common extra genital site, mostly on lips (3-90 days after exposure)

Penicillin is the drug of choice.

Candidiasis, caused by candida albicans (normal flora)

-opportunistic

C. albicans

Pseudomembranous candidiasis aka thrush

-looks like cottage cheeze in mouth, wipes off

-mild burning, wierd taste

-treat w/ antifungal troche or rinse, Nystatin

Erythematous candidiasis-red macules assoc. w/ burning, usually hard palate or dorsal tongue

-could be from denture stomatitis

-treat w/ Nystatin

HSV1

Primary infection(Acute herpatic gingivostomatitis)

Secondary infection(Herpes Labialis)

Treat with Acyclovir if caught early, or just treat symtoms (hydration, nutrition, pain relief)

initial exposure, no antibodies, the virus is taken up by the sensory nerves and colonized by the trigeminal ganglion remaining in a latent state.

This affects the movable tissues of the mouth which is unusual. typically occur b/w 6 months and 5 years.

Onset is abrupt, anterior cervical LAD, fever 103-105, nausia, anorexia, Malaise, sore mouth lesions

(recurrent infection)-affects any epithelium supplied by the sensory ganglion.

Most common site-Vermillion border and adjacent skin of the lip

-symtoms less intense than primary

-heals in 7-10 days

Recurrent Aphthous Ulcers aka canker sores (very common)

-no definite cause

-macule with central ulceration thats covered by yellowish-white fibrin membrane

-usually not HSV bc of location in the mouth (under tongue, inside of lips or cheek)

Erythema Migrans aka geographic tongue

Common and benign, can burn, but usually asymptomatic

 Lichen Planus

Relatively common, fine, lacelike network of white lines called Wickham's striae (typically posterior buccal mucosa bilateral)

-can be reticular or erosive, if erosive (rare) get a biopsy and use corticosteroids (eg-clobetasol gel).

Treatment for all-none, maybe corticosteroid if necessary

Squamous cell carcinoma

-arises from a preexisting leukoplakia or erythroplakia

-most commonly found on tongue, 2nd most common site is floor of mouth

-easily spreads to tissues of neck and throat through cervical lymph nodes.

Kaposi's Sarcoma

-Neoplasm of vascular endothelial origin

-rare, before AIDS

-purple lesions (oral lesions seen in 50% of pt's)

ENT PPt

Otitis Externa

1-definition

2-Pathogens and how they present in EAC visibly

3-Symptoms

4-Treatment

5-Complications

6-Clinical Features

1-Infection of the external auditory canal

2-Pseudomonas-green exudate, Proteus, Staph aureus-yellow crusting, E. Coli, (Fungal-fluffy breadlike mold-increased likelihood in immunocompromised pt's)

(also could be eczema-scaleing cracked weeping skin)

(TM may be red, but it moves normally as opposed to OM, canal may be very swollen, may not see the TM though)

3-Pruritis, exudate, decreased hearing, tenderness on traction of pinna and tragus, pain

4-Remove debris, avoid trauma and moisture, (Topical antimicrobials-Neomycin/polymixin B/hydrocortisone) use systemic antibiotics if severe and Fluconazol for fungal infections, treat dermatitis

5-Mastoiditis-tenderness over mastoid, Malignant OE-osteitis of bone underlying EAC, seen mostly in Diabetics or immunocomp. pts

6-Fever, severe pain, presence of friable granulation

Acute Otitis Media

1-definition

2-pathogenesis

3-Etiology

4-Risk factors

5-Symptoms

6-Signs

1-Bacterial infection of the middle ear (usually secondary to URI, most frequent in children bc ET's are still horizontal and also can collapse bc not fully developed.

2-Ventilation of middle ear space is accomplished by the eustachian tube

-negative middle ear pressure causes ET to collapse and increase negative pressure, this leads to accumulation of fluid and mucus in middle ear (becomes secondarily infected)

3-Strep. pneumoniae,H. influenzae, Moraxella catarrhalis, GASB, numerous viral pathogens

4-URI, nasal allergies, age, Male, smoke

5-Earache, fever, ear tugging, unilateral hearing loss, purulent otorrhea due to perforation of TM

6-TM w/ erythema, injection, bulging, loss of landmarks, immobile, conductive hearing loss, mastoid tenderness, purulent or serosanguinous discharge

Classification of Otitis Media (Middle ear)

1-Acute otitis media

2-Otitis media w/ effusion serous OM

3-Recurrent otitis Media

4-Persistant OM w/ effusion

5-Chronic OM

1-Pain, fever, TM is immoble and often red and bulging, frequenly follows a URI

2-Fluid in the middle ear, (w/out acute infection) amber fluid in middle ear w/ immobile TM. This happens commonly in kids bc ET's arn't developed and they colapse and cause fluid to back up, can put tubes in to keep them open

3-3 times/3months or > 4/year

4-effusion persists for 4-6 months, hypo or immobile TM, may occur w/ nasopharyngeal obstruction (adnoids) allergies

5-Purulent middle ear infection, perforation of TM, chronic otorrhea, hearing loss (staph, pseudomonas, proteus

1-Management of OM

2-Complications

1-AOM may resolve spontaneously in up to 50% of cases

-Amox HD or AM-CL ES or cephalosporins (PCN's)

-Surgical after 3 month of bilateral hearing loss

-Adenoidectomy

2-Reversible hearing loss, mastoiditis, labyrinthistis, osteomyilitis of temporal bone, facial nerve paralysis, Intracranial complications-epidural or subdural abscess, menningitis

Rhinitis

1-Definition

Viral Rhinitis

1-transmision and viruses

2-symptoms

3-treatment

1-transmitted by inhilation of droplets caused by hundreds of viruses-adenovirus, rhinovirus, RSV, coronovirus etc.

2-symptoms appear when immune system is fighting-stuffy nose, mucosal edema, rhinorrhea, sneezing, PND, cough, sore throat due to cough and virus -induced tissue damage.

3-Symptomatic-decrease smoking, vitamin C, salt water gargle, increase liquids, decongestants etc

Allergic Rhinitis

1-Seasonal

2-Perennial

3-signs

4-Management

1-occurs same time each year (pollen)

2-occurs throughout the year (dust, pet dander, mold, cockroach debris) season may exacerbate and may be a fam. hx

3-Swollen nasal membranes,enlarged turbinates,boggy and pale mucosa, allergic shiners, eye irratation

4-Avoidance, Drug therapy-(mild case-OTC benadryl, claritin)(Moderate-intranasal corticosteroids)(Severe-oral corticosteroids for short periods of time 3-5 days) Immunotherapy-when meds dont help, pt must have a + skin test(correlation of sx w/ allergen exposure

Acute Sinusitus (acute bacterial rhinusinusitis)

1-def.

2-pathogens

3-clinical presentation

4-symptoms

5-Findings

6-management

7-complications

1-pus traped behind a closed ostium, this causes a normally sterile environment to be backed up with forigners

2-Strep pneumoniae,Hinfluenza,M. catarrhalis, GABHS, fungal in immunocompromised

3-usually follows a viral URI "cold that lasts more than 7-10 days", may be a complication of allergic rhinitis, polyps, anatomical abnormality, pt w/ NG tube may have occult sinusitis as a cause of persistant fever

4-facial pain or pressure, nasal congestion w/ purulent discharge, pain in upper teeth, retro-orbital pain, cough, PND

5-Usually maxillary, tenderness, purulent nasal discharge, PND, perinasal and eyelid swelling, fever, transillumination my be opaque

6-Amoxicillin HD, AM-CL-ER, Cephalosporin (PCN's) azithro

7-Cellulitis, osteomyelitis, Cavernous venous thrombosis, Meningitis

Chronic Sinusitis

1-definition

2-Sx

3-Predisposing factors

4-Dx studies

5-Management

1-a sinus infection greater than 12 weeks

-determine whither the inflamm is in the nasal or sinuses

2- symptoms include PND, nasal cavity pain, nasal stuffiness/discharge, dental pain, chronic cough, facial fullness/discomfort, headache, etc

3-Smoking,Nasal polyps,Allergic rhinitis,Nasotracheal/nasogastric intubation,GERD,Periodontitis/significant dental disease,Damage to ostiomeatal complex,immunodeficiency

4- CT is the gold standard for evaluating sinus disease,MRI for complex cases,Nasal endoscopy, Cultures generally not useful

5-topical corticosteroids, nasal irrigation, antibiotics, Endoscopic surgery

-May be exudative or non-exudative

Viral Pharyngitis

1-caused by

2-Adenovirus

3-Coxsackieviruses

4-HSV

5-Epstein-Barr virus (HSV)

1-common URI

2-Associated w/ triad of conjuntivitis, pharyngitis and preauricular LAD-lymphadenopathy

3-may cause pharyngitis alone or may include pharyngeal vesicles and ulcers w/ vesicularpapular rash on hands and feet -GI Sx-anorexia, vomiting and diarrhea

4-pharyngitis w/ gingivostomatitis w/ fever and poor oral intake

5-my resemble strep, w/ exudate and erythema, may have headache, fever, malaise, rash, PE-fever, exudate on tonsils, posterior cervical LAD and Splenomegaly   Dx-may be made by rapid agglutination and enzyme immunoassays, peripheral lymphocytosis with increased atypical lymphocytes is characteristic

Management-get some rest

Bacterial Pharyngitis

1-describe

2-scarlet fever

3-GABHS may result in (*autoimmune)

4-Dx

5-Management

Group A Beta-hemolytic Strep

-rarely encountered under age 2

-mostly in children and young adults

Sudden onset Presents with fever, tender ant. cerv. nodes (absent-cough/nasal congestion) and sometimes-headache, malaise,rash,abdominal pain, vomiting

2- rash is a truncal, fine, maculopapular rash, most intense in groin and axillae, which develops as a result of exotoxin-producing strains of GAS

3-Rheumatic fever w/ resultant heart disease

Glomerulonephritis-acute renal failure

4-Throat culture is gold standard, rapid antigen test is about 90% may have leukocytosis

5-IM-Pen G benzathine

oral abx-Pen V, amoxicillin, erythromicin, azithromycin,cephalosporins, clindamycin

other bacterial Pharyngitis

3

 •Neisseria gonorrhoeae