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Oral Health
KYCOM Block 8
195
Medical
Graduate
04/24/2013
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Term
Where does most cancer occur
 Definition
Lung, prostrate, stomach
Term
What has increased survival rates of cancer
 Definition
Prevalence of HPV related cases and their Better prognosis
Term
What are the the types of oral cancer, what is the majority
 Definition
Melanoma, soft tissue sarcoma, bone sarcoma, odontogemic malignancies, squamous cell carcinoma (majority)
Term
Mortality of oral cancer: reducing, survival percent at 5 years, risk factors
 Definition
Reduced with early detection and early tumor stages

Local involvement has 80% 5 year survival, lymph involvement is 50%

Low level of dental cwre
Term
What are the general clinical patterns or oral cancer
 Definition
Granularity, chronic ulceration, leukoplakia, erythroplakia, mixture of all
Term
What are benign conditions that look like oral cancerous granularity. Why is it especially important to diagnose this visually?
 Definition
Inflammatory papillary hypoplasia (from dentures). Has cancerous markers If biopsied
Term
What are benign conditions that look like cancerous oral chronic ulceration
 Definition
Chronic ulceration from trauma (which would resolve in 7-15 days)
Term
What is a leukoplakia, what signs show it may be cancerous
 Definition
White patches in mouth (clinical term not diagnosis)

Cancerous may be white, red, or mix
Term
What are areas at high risk for dysplastic leukoplakia
 Definition
Floor of mouth, ventral and lateral tongue, soft palate, tonsilar pillar lingual retromolar trigone complex
Term
What are benign conditions that may look like cancerous leukoplakia
 Definition
Lichen planus, papilloma, leukoedema, white sponge nerves, morsicato buccarum, nicotine stomatitis, tobacco pouches
Term
How is lichen planus diagnosed
 Definition
Atypical erythematosis, granular, or indurated area resistsnt to intervention.

May have erythematosis or ulceration later.

Porcelain pinhead papilla on mucosa in stria (Wickhams), almost purple, polygonal, rarely plaqued, does not rub off
Term
Way is the cause of lichen planus
 Definition
T lymphocytes attack basal cell layer of skin and mucosa
Term
How is a papilloma diagnosed
 Definition
Hypekeratotic, white, finger like projections, occasionally white papillae
Term
What conditions look similar to papilloma
 Definition
Verruca vulgar is, condyloma acuminatum
Term
What are the steps to take once you find out someone has papilloma?
 Definition
Evaluate for immune compromised if reoccurring, remove and check for re-innoculation
Term
Leukoedema: clinical presentation, cause, testing
 Definition
Bilateral alteration of mucus, excess fluid in mucosa stratum spinoum, occurs more in blacks, mucosa with white gray or opal hue

Stretch and examine for changes, no treatment
Term
White sponge nerves / hereditary benign infra epithelial dyskerwtosis (HBID): cause, appearance, treatment
 Definition
Autosomal dominant, buccal mucosa lesion usually bilateral and symmetrical, whit spongy, thickened, eye involvement, seasonal

Epithelium did not mature properly

No treatment
Term
Morsicato buccarum: cause, location, appearance, treatment
 Definition
Cheek biting, chewing, or sucking
Common on labial mucosa and lateral tongue
White saggy hyper keratosis

Cheek guard may be needed
Term
What is a disease that can look like morsicato buccarum, how is it different
 Definition
Cinnamon aldehyde reaction. It burns
Term
Nicotine stomatitis: cause, appearance, symptoms, treatment
 Definition
Heat from cigar or hot drinks

Red dots surrounded by white hyper keratosis
Salivary gland ducts have squamous metaplasia

Could become popular secondary ductwork hyperplasia

Biopsy if severe
Term
What are the early and later effects of tobacco
 Definition
Early: wrinkling with no white
Late: opaque white discoloration, leukoplakia. Verrucous carcinoma and squamous cell carcinoma
Term
What is the process when checking a leukoplakia
 Definition
1. Use dry gauze to try and rake it off. Bleeding will occur if arythemus beneath. If it doesn't come off it is. Leukoplakia

2. Mechanical trauma diagnosis, assessment, prevention

3. Look for clinically diagnostic patterns
Term
If a leukoplakia rubs off what could it be from
 Definition
Trauma, candidiasis with erythematosis mucous beneath, meteria alba, necrotic epithelium, fibrinoourulent membrane
Term
What is an erythroplalkia
 Definition
Red patch not inflammatory in origin
Term
What benign conditions look like erythroplalkia
 Definition
Palatal hemorrhage, palatial petechiae, erythema margins, median rhomboid gossitis, candidiasis, epithelial atrophy, nonspecific mucositis, dysplastic lesions
Term
What are the signs of mucosal hemorrhage. Give a brief reason for each
 Definition
Opalescent sheen due to translucent epithelium, RBC extravasion causes hemorrhage (petechiae) or larger areas (purpura) or exceeding 2 mm (ecchymosis), yellowish due to breakdown of extravasated RBC in few days, quick resolve
Term
What are the causes of mucosal hemorrhage
 Definition
Surgery complication, trauma, infectious mononucleosis, thrombocytopenia, increased intra thoracic pressure
Term
Palatial petechiae: cause, location
 Definition
Negative pressure from increased intra thoracic pressure caused by cough, vomit, convulsion, birth

In midline palate
Term
what are the other names for erythema migrans
 Definition
grographic tongue, migratory glossitis, migratory somatititis, ectopic geographic tongue, erythma cicinta, idiopathic acute mucositis
Term
what are signs of erythma migrans
 Definition
erythma with atrophy of filiform papillae with raised yellow circular border, most commonly on tongue, higher in reiter's disease and psoriasis, sensitivity to hot or spicy food, not often symptomatic
Term
what is the cause and treatment of erythema migrans
 Definition
neutrophils that just shaved white areas off and are in yellow border

topical anesthetic, steroids. doesnt usually work well
Term
median rhomboid glottis: AKA, causes
 Definition
central pepillary atrophy

erythema and papillary atrophy in midline dorsal dongue. regressive alteration in adults, candidiasis is a secondary infection (often kissing lesion on palate

median raphe is hypovascular with age and decreases in effectiveness leading to atrophy of filiform papillae
Term
median rhomboid glottis treatment
 Definition
antifungal for secondary canidia infection, surgical removal and de-development
Term
what are signs of candidias
 Definition
only rubbs off in desqumation, angular cheilitis, poor diet, recent illness, diabetes mellitus, dentures, hard arched palate, exrostomia, antibiotic therapy, immunodeficient
Term
what do dentures cause candidis, what is the treatment
 Definition
because tongue cannot get to the area on top of mouth and clean it

antifungals (nystatin, mycelex, nizoral)
Term
how is epithalial atrophy diagnosed
 Definition
biopsy or cytologic smear, non-specific mucositis on biopsy, may need hematologic evaluation to find cause

increased keratosis or displasia
Term
what are the causes of epithalial atrophy and treatment
 Definition
secondary infection due to B12, folate, Fe, or riboflavin deficiency

blood cell count, folate and B12, most are local and dont need treatment
Term
what is a cause for concern in epithelial atrophy treatment
 Definition
mistreatment in B12 or folate choice can lead to demyelination is folate is chosen and B12 is issue and it is permanent
Term
what might a tooth ache also present as, why
 Definition
sinus infectioon because maxillary teeth go into maxillary sinus
Term
gingiva: color, contour, consistency, *composition*
 Definition
o Color: light pink
o Contour: come to point between teeth (interdental papilla)
o Consistency: stippled consistency (of an orange peel)
o Composed of dense CT
Term
free vs attached gingiva: location, examination
 Definition
o Free gingiva: comes around neck of tooth, not attached to tooth or bone. Probing depths into this shouldn't be deeper than 3mm. Plaque and tartar pull this away and eventually pull the bone away.
o Attached gingiva: part bound to the bone
Term
**what is the name of the line between the attached gingiva and alveolar mucosa
 Definition
mucogingival junction
Term
maxillary frenum: complications, location, composition
 Definition
dense CT
if too low will create separation between teeth and will push open after braces

top middle
Term
lingual frenum: complications, location, composition
 Definition
if too high there are issues with speech
bottom under tongue
dense CT
Term
where are minor salivary glands, what is their contribution
 Definition
all over mough, 10% of saliva production
Term
what is the largest parotid gland, what nerve is near it, where does it drain, what complications did we talk about
 Definition
parotid
 has facial nerve in it
 drains via parotid duct (stinsons duct) into mouth on cheek side of maxillary molars
 Lots of calculus builds up on these teeth
Term
where does the sublingual gland open into
 Definition
 does not have a duct. It as many openings along top.
Term
submandibular gland: where does it empty
 Definition
 duct empties into floor of mouth on each side of frenulum
 Duct is on top of sublingual gland.
 Empties under tongue
Term
what are the functions of salive
 Definition
 acid buffering
 antimicrobials
 lubrication (ulcers)
 enzymes that assist with digestion
 Water mostly
 Does oral cleaning
 prevents Dry mouth
Term
dry mouth: causes, in who mostly
 Definition
• meds make it worse
• 20% men, 27% women. 30% elderly
o Diabetes, Alzheimer’s disease, anti-depressants, anti-histamines, anti-hypertensives
Term
muscles of mastication: function, innervation
 Definition
o chewing, open and close (all but one for close)
o innervated by V3
Term
masseter, temporalis, medial and lateral pterygoid: location function
 Definition
o masseter: at jaw. can get large strong and sore with grinding
o temporalis: on temple
o medial pterygoid: inside mandible, like masseter.
o lateral pterygoid: sole opener of the mouth
Term
innervation of muscles of facial expression
 Definition
facial nerve
Term
what happens if anesthesia misses and the parotid is hit
 Definition
paralysis of muscles of facial expression vis anasehesia of facial nerve
Term
whare the arteries that supply the face: main branches, their major contributions
 Definition
 internal carotid: supplies brain (and a little bit of occipital region of head)
 external carotid: supplies neck and face: lingual, facial, maxillary (some little fat man stole poppas…..)
Term
veins of the face: unusual features, big ones, important ones, why do we care about them
 Definition
o not organized
o facial does follow facial artery
o pterygoid plexus is big and important
o infection can travel to cavernous sinus from the veins because they don’t have valves
Term
what is the fastest nerve
 Definition
trigeminal
Term
what nerve do dentists block for maxillary teeth and mandibular teeth
 Definition
V2 maxillary
V3 mandibular
in maxilla there are pores in the bone and you can anesthetize individgual teeth without a block
Term
what CN do taste, where
 Definition
 CN 7 anterior 2/3 of tongue (via chordae typmani)
 CN 9 posterior 1/3 of tongue
 CN 10 epiglottis
Term
what is a unique use for the mental nerve
 Definition
 can be anesthetized for stiches of the lower lip or chin. (via lidocane) between the premolars
 intraoral injections are a lot better than traditional ways
Term
explain the structure of the tooth outsde to in
 Definition
o Enamel
o Dentin
o Pulp
o Bone
Term
where are the most dental caries in the world
 Definition
problem in rural areas and low socioeconomic groups
Term
why are caries recently on the decline
 Definition
decline related to fluoride in water
Term
what is florosis, what is a possible reason for it
 Definition
 Fluorosis: too much fluoride (might be in too many daily sources?)
Term
what is a caries
 Definition
o Infectious microbiological di sease of the teeth
o Results in localized dissolution and destruction of calcified tissues
o Clinical signs of demineralization or loss of tooth structure
Term
what is a cavity
 Definition
hole in tooth due to bacterial infection
Term
what are the causes of caries
 Definition
o Acidogenic bacteria in plaque metabolize carbs and produce organic acid poo
o Acid can cause lesion in inorganic part of tooth
o Mutans streptococci is the most common group of bacteria causing
Term
what are the stages of caries. explain how to distinguish them
 Definition
o Moderate stage: roughening of enamel, White spot lesion of decalcification
o Advanced stage: cavitation of lesion. Once black it is slowly progressing and harder
Term
in the advanced stage of caries we do root checking, why
 Definition
• Gums recede in patients who brush too hard or are older. Root is covered in cementum which can be brushed away and gets cavities easier and faster. One cavity spreads fast to other roots
Term
how can a carie be saved
 Definition
 Remineralization of damage occurs at pH > 6
 Saliva Ca and P supply building materials for re-mineralization
Term
on a ion level what causes a carie
 Definition
o Plaque sucks Ca and P out of the tooth but it cannot get back in because the plaque is in the way (along with fluoride)
o The closer it gets to the root, the more pain
Term
how can a carie be diagnosed via radiograph, why do we use this method
 Definition
 Imperative to find proximal decay (between teeth)
 Useful for diagnosis of caries
 Can help diagnose pit and fissure carries
 Ca removal shows up darker on x-ray
Term
what are the types of fillings, what are they made of, what are their down sides
 Definition
o Fillings break down and need to be redone, and carriers can form along edges
o Almingum filling: tin, mercury nickel
o Plastic fillings: have BPA, could cause cancer
o Glass ionmere fillings: have fluoride in them but break down fast
Term
when toes tetracycline staining occur, what does it cause
 Definition
 Occurs in developing teeth making line from that point in development
 May cause graying in adults
Term
what in children can cause more caries
 Definition
bottles
Term
what do you do to an abcessd tooth, why is it scary
 Definition
 need antibiotics
 decay can spread to brain
 needs to be extracted
Term
in what part of the exam is maxillofacial trauma addressed usually
 Definition
secondary survery
Term
what are the levels of severity for maxilofacial issues, give examples for each level
 Definition
1. Immediate / resuscitative / emergent
 Life threatening / sight threatening
2. injuries that need treatment in a few hours
 Severely contaminated wounds
 Patient is hemodynamically stable
3. Injuries that require treatment within 24 hours
 Facial fractures
 Lacerations
4. Injuries that can wait over 24 hours
 Most facial fractures
Term
what are the parts to a parimary survery, what maxillofacial issues should be noted in these three parts
 Definition
airway and C spine control: bilateral mandbular fracture can lead to airway obstruction, low GCS score (unconcious)

breating: complication of mandibular frecture

circulation: bleeding in maxilofacial region can be perfuse. scalp, nasal

dissability: eyes

exopsure: remove dentures or prosthesis, remove glasses or contacts
Term
what do you do if someone has a bilateral mandibular fracture
 Definition
use wire or your hands to pull the mandible away from the trachea
Term
what do you do if someone cut their scalp
 Definition
staple or raney clip it together immediatly, must be done before ambulance
Term
what do you do if someone has a nose bleed: severe and normal
 Definition
 Posterior: send tube through mouth then nose with a gauze on it. Pull tube to bottom of nasopharyngeal
 Replace every 24 hours due to systemic infection risk
 Interventional radiology or surgery may be needed
Term
how should you screen someones eye if there has been trauma, what do the results mean
 Definition
examine pupil: abnormality could mean issue

feel globe: if hard there could be a retrobulbar hemorrhage, if soft globe could have ruptured
Term
if someone has a retrobulbar hemorrhage what do you do
 Definition
o Oculocardiac reflex: brady cardia from vasovagal stimulation stretches orbital and periorbital tissues, could cause hemodynamic instability. May need operation to release entrapped tissues
o Pressure on optic nerve causes ischemia which in 90 min will cause blindness
o Lateral canthotomy and inferior cantholysis
 Lateral then inferior incision to decompress globe
Term
what are the steps in advanced trauma life support
 Definition
1. primary survey: airway and C spine control, breathing, circulation, dissability, exposure
2. hemodynamic stability
3. re-evaluation
4. talk to patient and examine systematically
Term
before you repair soft tissue you should think about
 Definition
facial nerve in tact, parotid duct, lacrimal system, and canthal tendons
Term
what are two maxilofacial concerns in the nose, how do you fix them
 Definition
•Nasal septal hematoma: Drain ASAP or permanent defect
• Rhinorrhea: CSF leak. Sent for detection of b2-transferrin
Term
what are 4 conditions you should be aware of in the eye (other than those considered to be an emergency) when thinking like a maxilofacial surgon
 Definition
• Hyphema: Blood in anterior chamber. Can stain if left for too long
• Ptosis: Drooping of eyelid suggests CN III issue. Damage of globe apex
• Fixed dilated pupil
• Subconjunctival hemorrhage
Term
what are4 things that a maxilofacial surgon looks at in the ears
 Definition
• Hemotympanum
• Otorrhea: CSF leak
• Lacerations
• avulsions
Term
where are the 3 le ford fractures
 Definition
• Le Ford I fracture: bottom corner of nose across maxilla
• Le Ford II fracture: medial upper corner eye, diagonal lateral across socket and mid maxilla
• Le Ford III fracture: mid bridge of nose to lateral eye and zygomatic process
Term
what are signs and results of a mandible fracture
 Definition
o Malocclusion
o Pain
o Step deformity
o Ecchymosis
o Caused by open fractures
Term
what is the treatment for a mandible fracture
 Definition
 Bridle wires, antibiotics, antibiotic rinse, soft diet
Term
what would the history be fore a personn with a maxilofacial infection
 Definition
o Pain, difficulty swallowing, difficulty handling secretions, difficulty breathing
Term
what would the exam look like in a patient with a maxilofacial infection
 Definition
o Toxic appearance, tripoding, swealling, horasness, trachycardia, trachypena, fever
o Limited mouth opening (trismus), elevation of tongue, deviation of uvula
o Only do radiograph if stable
Term
how is a maxillofacial infection managed
 Definition
o Airway
o Medically support: Fluid replacement, analegsics, assess host immune response and defenses, nutrition
o Surgical remove of source
o Surgical drainage of infection with replacement
o Antimicrobial given after culture and sensitivity testing
o Frequent re-evaluation
Term
what are 4 major complications of maxilofacial infection
 Definition
cavernous sinus thrombosis
ludwig angina, mediastinitis, high morbidity and mortality
Term
what is ludwig's angina, where, treatment
 Definition
 Submandibular, sublingual, and submental spaces
 Aggressive airway control needed, surgical drainage, medical management
Term
what are the symptoms and causes of cavenous sinus thrombosis, what is a worry
 Definition
 High morbidity and mortality
 CN involvement
 Facial veins don’t have valves so infection can spread into brain or thorax
Term
what are common locations of a maxilofacial infection
 Definition
o Retropharyngeal space
o Osteomylelitis
Term
what are symptoms, causes, and treatment of osteomyelitis
 Definition
 Non-healing wound
 Painful
 Purulent drainage
 Medical compormized host
 Reduced blood to maxilla / mandible
 Aggressive surgery and treatment
Term
what are the tissues of the peridontium
 Definition
o Gingiva
o Periodontal ligament
o Alveolar bone proper
o Root cementum
o Alveolar process
Term
define peridontal disease, what are two common peridontral diseases, when is it severe
 Definition
inflammation of the supporting tissues of the teeth
gingivitis, peridontitis
severe when 6mm of peridontal attachment loss
Term
what is the etiology or triad of peridontal disease
 Definition
o Specific infection
o Host response
o Environment
o The “dual challenge” is specific infection vs host response
Term
in the spatiotemporal model of oral bacteria colonization: who is the early colonizers, who are the late colonizers, what do late colonizers attach to
 Definition
o Other early colonizers attach to bacterial layer
o Final early colonizer is fusoacterium nucleatum
o Late colonizers attach to fusobacterium nucleatum
Term
what is dental plaque made of, how does it persist
 Definition
o Exists as biofilm
o Has food web and virulence web
o Virulence web sum of whole is greater than its parts
o Polymicrobial chalange to most
Term
what is a calculus
 Definition
Ca deposit that is noxious to peridontal tissue
Term
hwat is the local immune response in a host to plaque
 Definition
 Plaque formation and inflammation
 CD8, Th/Tc ratio changes
 acute phase proteins, IL-1, IL-8, PGE2, IL-6, INFg, THF-b, MCP-1, TNFa
 Increased IgA, increased IgG/A antibodies to the bacteria
Term
what is the systemic immune response to plaque
 Definition
 T cell sensitization
 Gm+ antibodies
 IgG/A antibodies to the bacteria
 Acute phase proteins
Term
how does the immune response get to plaqye
 Definition
molecules from circulation trabel down lymph vessels to tooth and salivary glands
Term
what questions should you ask on a clinical exam in relation to peridontal disease
 Definition
 When is the last time you had a dental check up
 Do you think you have bad breath
 Do your gums bleed when you brush your reeth
 Are any of your teeth loose
 Do either of your parents wear false teeth?
 Did your parents loose teeth at an early age?
 Medical implications: Do you have diabetes. Do you have cardiovascular disease. Are you pregnant
Term
what should you do in the visual assessment of a peridonal exam
 Definition
colon, contour, consistancy, texture
Term
what are the parts of a peridontal evaluation
 Definition
oral hygine assessment, probing depths, clinical attachment levels, mobility, check susceptible teeth, radiographic
Term
what is an oral hygiene assessment of a peridontal exam
 Definition
• Visual observation: red, swollen, recession, missing teeth, visible plaque, visible calculus
• Bad breath
Term
what does it mean if there is bleeding on probing
 Definition
inflammed papilla
Term
what should you check when looking at peridontal mobility
 Definition
• Loss of attachment, trauma, occlusion forces, inflammation, orthodontics, periodontal surgery
Term
what are peridontal susceptible teeth
 Definition
• Maxillary molars (facial, mesial, dista)
• Maxillary first pre molars (mesial, distal)
• Mandibular molars (facial, lingual)
Term
what are the different peridontal radiographic views
 Definition
periapical, bitewing, panoramic
Term
what are the types of peridontal therapy
 Definition
removal of local factors (scaling and root planting (deep cleaning), oral hygiene instruction, surgical therapy, adjunctive drug therapy (antimicrobial, host modification)
Term
preventitive education for peridontal health: how to clean teeth
 Definition
 At gumline, gingival margin (45 deg), beneath gumline (horizontal movement of brush), rotate away from gumline, overlap strokes, don’t forget biting (occlusional surfaces)
 Interproximal cleaning: floss
 Change toothbrushes
Term
how is calculus detected
 Definition
 Visual observation
 Gnigiva color change
 Explorer response
 Air
 Radiographs
Term
what is necrotizing ulcerative peridontal disease symptoms and who has it
 Definition
in immune compormized
pain, bad breath, punched out papillae, fever
Term
what age group and state has the highest rate of dental decay
 Definition
elderly from 60-80 yo, kentucky
Term
what is the number one childhood disease
 Definition
caries
Term
what is the outcome to caries
 Definition
pain, infection, digestive issues, halitosis, self confidence issues, distraction, impaired learning, unable to trear due to expense
Term
what is the cause of caries in kids
 Definition
streptococcus mutans transmitted from mother to baby after erruption of first tooth via kissing, tasting, etc in first few months of life, nursing from a bottle, sugars (amount, length of exposure, time between cleaning)
Term
what are the outcomes of peridontal disease
 Definition
diabetes, stroke, heart disease, low birth weight, pre term babyes, alzheimers
Term
what is the impact of poor oral health on children
 Definition
o Educational
o Name calling
o Pain
o Missed school
o Economic: cannot get hired
o Psychological: self esteem
o Expenses
o Irreplaceable lost teeth
Term
what are problems with access to dental care in kids
 Definition
o Medicade of KCHIP dental benefits: Dentists done participate: low payment, don’t cover costs, non-standard forms to fill
o Rural areas have few dentists
o Transient families
 Move a lot, change school, can’t reach at phone, mail, or school
 Not all dentists treat kids
 Specialists are even more rare
 Parent compliance :Transportation, priorities, attitudes, survival, beliefs, fear of dentists, trust, comfort, apathy
Term
what is a caries risk assessment, what are the key components to check
 Definition
 Treat disease process instead of outcome (chronic vs acute model of care)
 Individgualizes care per child
 Factors: Things that directly cause the disease, Things useful in predicting disease, Things protective against the disease
 Remember to check: Dietary habits, Fluoride history, Sleep time habits, Oral hygiene
Term
what should you tell pregnant patients
 Definition
• Have dental cleaning
• Fill cavities, pull infected teeth during second trimester
• Xylitol gum decreases bacteria
Term
what should you tell 0-6 mo old patients
 Definition
• Fluoride in water / fluoride tablets
• Avoid sleeping with bottle
• Water only in bottle except at meals
• No pop ever
• Clean teeth and gums daily with wash cloth
Term
what should you tell 6-18 mo old patients
 Definition
• First year, first tooth, first dental visit
• Wean from bottle 12-24 mo
• Sippy cups only have water
• No pop ever
• Clean teeth with small brush
Term
what should you tell 18-24 mo old patients
 Definition
• Thumb sucking Is normal until age 4
• Never dip pacifier into sweets
• Limit starches in snacks
• No pop ever
• Brush teeth twice a day with grain of toothpaste (not training toothpaste, no fluoride)
Term
what should you tell 2-5 year old patients
 Definition
• Check-ups ever 6 mo
• No pop ever
• Parents still brush twice a day with fluoride, pea size
• Floss
Term
what should you tell 6-12 year old patients
 Definition
• Sealants on permanent molars (6 year and 12 year)
• Pop at parties only, pop once a week
Term
what should you tell 12-21 year old patients
 Definition
• More susceptible to gum disease due to hormones
• No Mt. Dew, limit pop
• Monitor smoking, drinking, smokless tobacco, drugs
Term
what is the children's drink pyramid
 Definition
o Pop at parties
o Juice just once a day
o Milk with meals
o Water whenever
Term
flouride varinish
 Definition
o Covered by medicade for $15 reimbursment
o Allowed every 90 days, twice per year
o Topical lacquer
o Prevents decay, stops current decay, heals current decay
Term
Submental Region location
 Definition
the area just below the chin
Term
Submandibular Region location
 Definition
the area just below the lateral inferior borders of the mandible.
Term
Angle of the Mandible location
 Definition
the junction of the body of the mandible and the ramus.
Term
Temporomandibular joint definition and location
 Definition
The craniomandibular articulation just in front of the ear
Term
Muscles of mastication: location, attachments
 Definition
Temporalis – the large fan shaped muscle that covers the temporal bone and inserts on the coronoid process of the mandible.
Masseter- this rectangular muscle runs from the zygomatic arch downward to the lateral aspect of the lower border of the ramus of the mandible
Term
Parotid Gland: location, palpation
 Definition
the largest of the three paired major salivary glands that is located at the posterior border of the mandibular ramus and below the ear; not palpable in health.
Term
Hyoid Bond : location, shape, function
 Definition
a "U" shaped bone just superior to the thyroid cartilage that serves as attachment for infrahyoid and suprahyoid muscles.
Term
Thyroid Cartilage: location, shape, function
 Definition
the large butterfly-shaped cartilaginous ring which forms the upper extent of the trachea and encompasses the larynx; found in midline of upper neck; noted; most prominent in males ("Adam's apple").
Term
Thyroid Gland: location, palpation, shape
 Definition
a butterfly-shaped gland found in the middle of the anterior neck; composed of two lateral lobes joined by an isthmus; located below thyroid cartilage; not usually palpable in health.
Term
Lymph Nodes: list them, function, palpation, why would they be enlarged
 Definition
specialized organs located at various sites along lymphatic vessels that (1) phagocytize foreign material and microorganisms and (2) produce lymphocytes. Not palpable in health. Lymph node enlargement commonly due to allergy, infection, primary or metastatic cancer. Palpable nodes are tender or non-tender, firm or soft, fixed or movable. Normal lymphatic drainage pattern in the head and neck is inferior and posterior.

submental, submandibular, facial, cervical, auricular
Term
Sternocleidomastoid Muscle : location, attachments, what is by it
 Definition
the large muscle on the lateral aspect of the neck that runs from the mastoid process to the sternum and clavicle. Lymph nodes are found along the entire length of this muscle both in front and behind.
Term
Vermillion Portion of Lip : color, location
 Definition
the red portion of the lip; pink and uniform in appearance
Term
Vermillion Border : location
 Definition
the junction between the red portion of lip and the skin; should be sharply distinct.
Term
Commissure : location, formed by
 Definition
the corner of the mouth formed by the junction of upper and lower lip
Term
Philtrum : define, location
 Definition
the vertical groove in the median portion of the upper lip beneath the nasal septum.
Term
Labial Mucosa : composition, what is in it, location
 Definition
the lining covering the inner surfaces of the lips; color of mucosa determined by vascularity, keratinization and pigmentation. Accessory salivary glands present throughout upper and lower lip.
Term
Labial Frenum : location, define
 Definition
folds of tissue that connect the lips with the alveolar ridge.
Term
Accessory (Minor) Salivary Glands : location
 Definition
small salivary glands found in the lips, palate, cheeks, etc. and empty into the oral cavity via small duct openings.
Term
Buccal Mucosa : composition, what is in it, location
 Definition
the lining covering the inner surfaces of the cheeks; color of mucosa determined by vascularity, keratinization and pigmentation. Accessory salivary glands present in the buccal mucosa.
Term
Parotid Papilla : define, location, function, testing
 Definition
the elevation of tissue on the buccal mucosa opposite the maxillary molars that is the opening of the duct of the parotid gland; the gland may be milked to produce saliva at duct orifice.
Term
Vestibule : location, formed by
 Definition
the trough or gutter formed by the junction of the lips and alveolar ridges or the cheeks and alveolar ridges.
Term
Alveolar Ridges : function, location, what happens over time
 Definition
those portions of the maxilla and mandible that support and retain the dentition; these bony ridges are gradually lost (resorbed) following loss of teeth.
Term
Alveolar Mucosa : composition, function, attachment
 Definition
the lining tissue that covers the lateral portion of the alveolar ridge that is not attached to bone; very vascular, non-keratinized and movable.
Term
Gingiva (Attached): color, appearance, texture, location
 Definition
the lining tissue that covers the facial and lingual portion of the alveolar ridge that is tightly bound down to underlying bone and has a stippled (orange peel) surface; has a coral or salmon pink color and a fibrous appearance.
Term
Mucogingival Line : location
 Definition
the junction between alveolar mucosa and gingiva
Term
Marginal Gingiva (Free Gingiva) : what does it form, attached to
 Definition
that portion of the gingiva that forms a collar around a tooth and is not attached to bone.
Term
Interdental Papilla : shape, location
 Definition
that triangular portion of the gingiva that fills the space beneath the contact areas between two teeth.
Term
Hard Palate : location, attachment, AKA
 Definition
the roof of the mouth that is supported by bone (palatine process of the maxilla).
Term
Incisive Papilla : location, covering the
 Definition
a small elevation of tissue in the midline of the hard palate just behind the central incisors; covering the incisive foramen.
Term
Rugae : location, function, composition, layout
 Definition
lateral irregular linear elevations of soft tissue located on the anterior portion of the hard palate; thought to aid in the mastication of food.
Term
Median Palatal Raphe : color, shape, location
 Definition
a white line down the midline of the hard palate; covers the union between the palatine processes.
Term
Fovea Palatinae : what is in it, what does it look like, location
 Definition
two small depressions in the midline at the junction of the hard and soft palate which represent the collective openings of accessory salivary glands.
Term
Maxillary Tuberosity : location
 Definition
the distal extent of the maxillary alveolar ridge.
Term
Soft Palate : composition, location,clinical correlation
 Definition
the soft, unsupported muscular portion of the roof of the mouth, behind the hard palate; composed of levator veli palatine, tensor veli palatine, palatopharyngeus, palatoglossus and uvulae muscles; vibration of the soft palate is a primary cause of snoring.
Term
Uvula : location, shape, composition
 Definition
the oval projection of soft tissue that extends inferiorly from the posterior border of the soft palate in the midline, composed of the uvulae muscle.
Term
Anterior and Posterior Tonsillar Pillars : formation, composition
 Definition
the linear vertical folds of tissue that form the tonsillar fossa; palatoglossus (anterior) and palatopharyngeus (posterior) muscles respectively.
Term
Palatine Tonsils :composition, location, function
 Definition
large aggregate of lymphatic tissue within the tonsillar fossca on the lateral wall of the pharynx; cryptic invaginations enhance the capture of bacteria and foreign material.
Term
Waldeyer's Ring : shape, composition, location
 Definition
roughly circular collection of lymphatic tissue that surrounds the oropharynx (adenoids, palatine tonsils, lingual tonsils, pharyngeal tonsils).
Term
Posterior Pharyngeal Wall :whats in it, composition
 Definition
the back of the throat formed by the superior pharyngeal constrictor muscle; frequently dotted with small mounds of lymphatic tissue.
Term
Pterygomandibular Raphe : shape, location, composition
 Definition
a linear bulge of tissue extending from the lateral aspect of the soft palate/tuberosity to the retromolar pad area; represents the union of buccinator muscle and the superior pharyngeal constrictor muscle.
Term
Tongue : functions, what covers it
 Definition
muscular organ that functions in speech, chewing, swallowing, respiration; dorsal surface covered with specialized epithelial structures (papillae).
Term
Foramen Caecum : location, looks like, why is it there
 Definition
a depression that may be found on the dorsal surface of the tongue at the junction of the posterior and middle thirds; point of invagination of embryonic thyroglossal duct.
Term
Filiform Papillae : color, shape, location, function
 Definition
the thin whitish epithelial projections on the dorsum of the tongue; most numerous of the tongue papillae; function in food movement as well as in textural and pressure sensitivity
Term
Fungiform Papillae
 Definition
small, flat, round epithelial projections on the dorsum of the tongue nestled between the filiform papillae; contain taste buds.
Term
Circumvallate Papillae
 Definition
large, raised, mushroom-like flat epithelial projections found in a "V" shaped line at the junction of the middle and posterior third to the dorsum of the tongue. The apex of the "V" points posteriorly; also contains taste buds
Term
Foliate Papillae
 Definition
flat, vertical slits found on the lateral posterior aspect of the tongue; contain taste buds.
Term
Taste
 Definition
taste buds are specialized sensory receptors that are found in fungiform, circumvallate and foliate papillae and also in mucosa of epiglotis, palate and pharynx; sweet, sour, salt, bitter; cranial nerves 7, 9, 10.
Term
Lingual Tonsils
 Definition
aggregates of lymphoid tissue often found on the posterior dorsal and posterior lateral aspects of the tongue; often in proximity to foliate papillae.
Term
Body of the Tongue
 Definition
the tongue should be palpated for the presence of masses or induration.
Term
Ankyloglossia
 Definition
"tongue tied"; due to a short, fibroud lingual frenum that prevents protrusion of the tongue.
Term
Lingual Frenum
 Definition
the fold of tissue that attaches the ventral surface of the tongue to the floor of the mouth.
Term
Plica Fimbriata
 Definition
thin, elongated folds of tissue found bilaterally on ventral surface of tongue on each side of lingual frenum; fringed or "fimbriated" structures that are ducts of accessory salivary glands; the vasculature on the ventral surface of the tongue is often quite prominent.
Term
Sublingual Folds
 Definition
bilateral linear elevations of tissue in the floor of the mouth formed by the ducts of the submandibular and sublingual glands.
Term
Sublingual Caruncles
 Definition
the two small elevated mounds of tissue at the base of the lingual frenum which are the openings of the ducts of the submandibular glands.
Term
Sublingual Glands
 Definition
the smallest of the three paired major salivary glands; elongated, irregular surfaces, just beneath the mucosa in the floor of the mouth adjacent to the inner surface of the mandible at the canine-premolar area; empty into the submandibular ducts.
Term
Submandibular Gland
 Definition
one of the three paired major salivary glands which lies behind and beneath the posterior border of the mylohyoid muscle in the region of the 2nd and 3rd molar. Lies below the retromylohyoid fossa; about the size of a large graphe; drained by the submandibular duct.
Term
Retromylohyoid Fossa
 Definition
the space formed by the lower posterior lingual surface of the mandible and the lateral ventral surface of the tongue.
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