Oral Cavity, Salivary Gland Diseases

Disorders of the Oral Cavity

• Dental plaque is a gluey, gelatin-like substance that adheres to the teeth.
• Tooth decay is an erosive process, beginning with the action of bacteria on fermentable carbohydrates in the mouth, producing acids that dissolve tooth enamel.
• Prevention involves brushing and flossing, decreasing sugar and starch intake, and using fluoridated water, toothpaste, or mouth rinse.
• Treatment includes tooth fillings, dental implants, or extraction.
• Dentoalveolar/Periapical Abscess, also known as an abscessed tooth, involves pus collection in the apical dental periosteum and surrounding tissue.
• Clinical manifestations include dull, continuous pain; cellulitis and edema of facial structures; mobile tooth; gingivitis; and fever.
• Medical management includes needle aspiration or drilling to relieve pressure and pain, gingiva incision for drainage, tooth extraction or root canal therapy, and antibiotics and opioids.
• Nursing management involves instructing the patient to use a warm saline or water mouth rinse and administering prescribed antibiotics and opioids.
• Nurses should assess the patient's ability to advance from a liquid to a soft diet.
• Candidiasis, also known as Moniliasis or Oral Thrush, caused by Candida Albicans Fungus, with predisposing factors like DM, immunosuppression, prolonged intubation.
• Signs and symptoms include a cheesy white plaque resembling milk curds that may bleed when rubbed off.
• Management involves antifungal medications like Nystatin, Amphotericin B, Clotrimazole, and Ketoconazole.
• Stomatitis is the inflammation of the oral mucosa.
• Causes include chemotherapy, radiation therapy, and bacteria.
• Symptoms: mild redness (erythema), painful ulceration, and secondary infections.
• Nursing management includes mouth care for patients receiving chemotherapy and radiation therapy.
• Avoid alcohol-based mouth rinses and hot and spicy food.
• Medical management includes anti-inflammatory, antibiotic, and anesthetic agents.
• Oral cancer causes include tobacco and alcohol use.
• Predisposing factors: common in men and those over 60.
• Manifestations include leukoplakia, dysphagia, and pain, especially with seasoned foods.
• Diagnosis: biopsy
• Treatment involves surgery, radiation, and chemotherapy.

Disorders of Salivary Glands

• Parotitis means inflammation of the parotid gland, the most common inflammatory condition affecting the salivary glands.
• Causes include Staphylococcus aureus, prolonged intubation, dehydration, and certain medications that decrease salivary production.
• Symptoms: fever, otalgia, dysphagia, and red, shiny overlying skin.
• Nursing management includes oral hygiene, nutrition, fluid intake, and warm compresses.
• Antibiotic therapy, analgesics, and discontinuing tranquilizers and diuretics used as medications.
• Chronic parotitis treated with parotidectomy, gland is incised and drained.
• Mumps (Epidemic Parotitis) is a communicable disease caused by a viral paramyxovirus infection.
• Mumps results in inflammation of the parotid gland, commonly affecting children, managed through isolation, sedatives and analgesics.
• A complication of mumps is orchitis in males.
• Sialadenitis is the inflammation of the salivary glands, commonly the sublingual and submandibular glands.
• Causes: dehydration, radiation therapy, stress, malnutrition, salivary gland calculi, poor oral hygiene, and bacterial infections.
• In hospitalized patients, it is caused by methicillin-resistant Staphylococcus aureus (MRSA).
• Signs & Symptoms: pain in the ear, swelling, and purulent discharge.
• Management: massage, hydration, warm compress, antibiotics, & corticosteroids.
• Surgical: surgical drainage of the gland or excision of the gland indicated.
• Sialolithiasis involves salivary calculi (stones), usually in the submandibular gland
• Calcium phosphate deposits are the primary cause.
• Diagnostic: sialography (salivary gland ultrasonography) visualizes irregular calculi with diameters from 3–30 mm via X-ray after radiopaque substance injection into the duct.
• May be asymptomatic, infection, or colicky pain in swollen glands
• Surgical: lithotripsy uses shock waves to disintegrate stones without anesthesia, sedation, or analgesia.
• Local hemorrhage and swelling are side effects lithotripsy
• Nursing Management: Admise patient to chew sugarless gum, increase oral fluid intake , and application of moist warm heat

Disorders of the Esophagus

• Achalasia: Absent or ineffective peristalsis in the distal esophagus, with failure of the esophageal sphincter to relax.
• Caused by neuronal impairment that innervates the lower esophagus, resulting in LES stenosis.
• Manifestations: Dysphagia on both liquids and solids, sensation of food sticking, regurgitation, pyrosis (heartburn), and aspiration.
• Assessment and Diagnostic Findings: X-ray studies (UGIS or barium swallow) show esophageal dilation above the narrowing.
• Manometry measures esophageal pressure, used as a confirmatory test.
• Medical Management: Calcium channel blockers (e.g., Verapamil), nitrates (e.g., Isosorbide Dinitrate), and Botulinum toxin (Botox) injected to inhibit smooth muscle contraction.
• Pneumatic Dilation disrupts the LES muscle using progressively larger balloons, dilated endoscopically.
• Perforation is a complication of Pneumatic Dilation.
• Esophagomyotomy / Heller's Myotomy: Surgical separation of esophageal muscle fibers to relieve lower esophageal stricture and may include antireflux procedure.
• Nursing Management involves small, frequent feedings, with fluid intake, elevated head while sleeping, and avoiding constricting clothing.
• Observation for complications like (perforation, bleeding) after surgery is essential.
• Hiatal Hernia involves the enlargement of the opening in the diaphragm, allowing the upper stomach to move into the thorax.
• Clinical Manifestations Slides includes heartburn, regurgitation, dysphagia and asymptomatic presentation.
• Paraesophageal Clinical Manifestations includes sense of fullness, pyrosis after eating, and the gastroesophageal sphincter remains intact
• Assessment and Diagnostic Findings: Diagnosis confirmed via X-ray studies, barium swallow, and fluoroscopy.
• Medical Management: Antacids and antiemetics used
• Surgical Management: Herniorrhaphy to close and Gastropexy, to prevent reherniation
• Diverticulum: Is an outpouching of mucosa and submucosa through a weak portion of the musculature.
• Pharyngoesophageal (upper area), Midesophageal area), and Epiphrenic (lower area) are of location. Zenker's Diverticulum, the most common type, is located midline of the neck
• Occurs posteriorly through the cricopharyngeal muscle
• Clinical Manifestations: Dysphagia, neck fullness, belching, regurgitation, gurgling noise, aspiration, coughing, and halitosis.
• Diagnostic: Barium Swallow visualizes nature and location of the diverticulum. Esophagoscopy and NGT insertion are contraindicated due to of perforation
• Intervention: Diverticulectomy is the is the surgical intervention
• The pt NGT is is inserted at the time of surgery, with NPO status postoperatively.
• Observe surgical site for evidence of leakage from the esophagus
• Advance from liquids if without complications
• Esophageal Perforation causes include stab or bullet wounds, trauma, or surgical instrument puncture
• Clinical Manifestation: Persistent pain, infection, hypotension, lung collapse
• Diagnostic findings confirmed via barium swallow or esophagogram
• Complications: Mediastinitis
• Broad antibiotics, pt will require NPO with parental nutrition for management
• The upper part of the damaged Esophagus is attached to the neck and lower chest is closed to allow for drainage of Spit Fistula
• Reconnection can occurs months later
• Nursing management: Pt must remain NPO with total parental support
• Chemical Burns: Can be caused by strong acids or bases
• Signs and Symptoms: Burns of the lips, mouth, and pharynx, Odynophagia and dyspnea
• Immediate esophagoscopy and barium indicated test use to determine severity and extent of esphagus damange
• Emergency management includes NPO, Administration of IV, and NGT to wash and remove the irritant
• Keep the patients NPO and initiate broadspectrum antibiotic therapy = Use Bougienage Dilation and Esophagectomy & Colon Interposition Reconstruction to dilate damage
• GERD the backflow of gastric or duodenal contents into the esophagus.
• Caused by an incompetent LES, triggered by foods high in caffeine and chocolate), hiatal hernia, obesity, pregnancy, or cigarette smoking-
• Assessment: Mimics of heart attack, requires use of use Endoscopy, Barium Swallow, and pH monitor for accurate findings
• Management: requires Low fat diet, avoid foods peppermint and caffeine , No food and drink, before bedtime.
• Medications include aluminum hydroxide, Magnesium salts, and Bicarbonate of soda to reduce gastric acid. (Administer histamine receptor and proton-pump to neutralize the HCL Prokinetic agents (urecholine, reglan)
• Increase GI motility, surgical procedures such as wrapping
• Barrlett - a condition that leads to altered lining. The abnormal lesion lead to rise of esophageal cancer.
• Leads to heart burn. Diagnosed with a lining during normal examination
• Medical procedures is is perfomed to detect any abnormalities and risk is detected increased.
• Managed with medications, and surgery. Requires biopsy monthly

Test your knowledge on oral and salivary gland diseases, covering topics such as causes, symptoms, and treatments. Questions cover oral cancer, parotitis, sialadenitis, and diagnostic procedures. Review causes, symptoms, diagnostic procedures, and treatments.