Term
| Describe the topicgraphical anatomy of the inside of the mouth. |
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Definition
Oral cavity = vestibule and mouth cavity
nasopharynx = above soft palate; eustachian tubes open into the sides of the nasopharynx; adenoidal (lymphoid) tissue lies on the posterior wall
orophayrnx = from soft palate to hyoid bone; palatine tonsils on lateral walls
hypopharynx = from hyoid bone to cricoid cartilage;
salivary glands = 1/2 liter secretions/day
-parotid glands - drain via Stensen's ducts near upper 2nd molar
-submandibular glands - drain via Wharton's ducts on either side of lingual frenulum
-sublingual glands - beneath oral mucosa; forms a ridge adjacent to the tongue
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Term
| What is the role of palpation in performing a thorough oral examination? |
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Definition
Palpation of oral cavitiy may detect intraoral cancers;
palpation of tongue will detect oral cancers long before they become visible |
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Term
What is the significance of hairy leukoplakia?
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Definition
| Hairy leukoplakia occurs on the lateral surfaces of the tongue. Keratin projections give the lesion its hairy appearance. Associated with HIV, secondary to Epstein-Barr virus infection of keratinocytes. |
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Term
Know the common presentations and causes of angular stomatitis.
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Definition
Angular stomatitis - Patient presents with reddening and cracking at one or both angles of the mouth. Superfician ulceration and crusting is common.
Secondary to continuous drooling, vitamin B deficiencies, and iron deficiency. |
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Term
Know the common clinical presentations and causes of macroglossia.
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Definition
| Pt. presents with abnormally large tongue. Associated with amyloidosis, Down's syndrome, and hypothyroidism. May be due to infiltration with proteinaceous material or muscle hypertrophy. |
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Term
| What are the findings on exam suggestive of Strep throat? How reliable are these findings in distinguishing Strep throat from other causes of pharyngitis? |
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Definition
there is no sure way to distinguish Strep throat from viral pharyngitis on exam. Findings indicative of Strep throat include pharyngeal exudate, cervical lymphadenopathy, and history of headache (102) and nause with the onset of pharyngitis.
Erethema of the pharynx commonly develops with viral and strep throat. Onlly 5-15% of adults with pharyngitis have strep throat. |
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Term
| Develop a differential diagnosis for staining of the teeth. |
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Definition
Lead line - a darkly pigmented line paralleling the insertion of the teeth at the gum line may occur in patients with lead poisoning.
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Brown discoloration of the teeth - is common in smokers. Its caused by the use of tetracycline during pregnancy or infancy. Dead teeth appear darker than healthy teeth.
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Smoking
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Term
Know the common presentations and causes of luekoplakia.
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How do you differentiate between squamous cell carcinoma of the oral mucosa, oral candida, and hairy luekoplakia--all which present with leukoplakia? |
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Definition
leukoplakia = "white lesion"
linea alba = white spots or lines on the oral mucosa result from thickening of the mucosa and due to biting (chronic minor trauma)
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squamous cell carcinoma = the luekoplakia cannot be scraped off with a tongue depressor
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candida = the leukplakia can be scraped off since it's secondary to infections; usually has red margins; children get this more than adults, unless the adults are immuno-compromised or on steroids.
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hairy leukoplakia = occurs on the lateral surfaces of the tongue; has hairy projections of keratin; associated with HIV secondary to Epstein-Barr virus infection
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Term
Know the common presentations and causes erythroplakia.
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Definition
| erythroplakia - Pt. presents with a sharply delineated area of varying size of reddened mucosa. It is particular common in the floor of the mouth, and in retromolar areas. More than half of these red areas represent invasive carcinoma. |
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Term
Know the common presentations and causes of hyperpigmentation of the buccal muccosa.
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Definition
hyperpigmentation of the buccal muccosa - common
(1) Smokers - diffuse hyperpigmentation of the anterior buccal mucosa and gingiva => smoker's melanosis
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(2) Primary adrenal insufficiency - diffuse hyperpigmentation of the skin, secondary to increased production of ACTH, similar to MSH (melanocyte stimulating hormone)
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(3) darked skinned races
(4) Peutz-Jeghers syndrome - spotty buccal hyperpigmentation, characterized by intestinal hamartomatous polyps and increased pigmentation of the lips and buccal mucosa secondary to melanin deposition (inherited)
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Term
Know the common clinical presentations and causes of hairy tongue.
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Definition
| hairy tongue - beningn overgrowth and discoloration of the filiform papillae on the anterior two-thirds of the tongue. May be associated with a foul taste or odor. Associated with smoking or oral antibiotics. |
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Term
Know the common clinical presentations and causes of geographic tongue.
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Definition
geogrpahic tongue - pt. presents with circumscribed paches of atrophic reddish muccosa, bordered by thin margins of hypertrophic mucosa.
due to loss of filiform papillae, anterior 2/3rds of tongue.
benign, asymoptomatic |
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Term
Know the common clinical presentations and causes of glossitis.
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Definition
Glossitis - tongue inflammation that manifests as papillary hypertrophy or atrophy (atrophic glossitis).
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Patients may report no symptoms, a change in taste, or burning of the tongue.
The tongue may appear to be pale, smooth, shiny and devoid of papillae, or strawberry red and granular.
Causes for glossitis include iron deficiency, B vitamin deficiency, alcoholism, inflammatory bowel disease, amyloid, and bacterial infections. |
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