Oral Health and Mumps Quiz

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Questions and Answers

What is a significant clinical feature of xerostomia?

Swollen salivary glands

Improved taste sensation

Dry mouth with burning sensation (correct)

Excessive saliva production

Which condition could lead to duct obstruction?

Presence of a foreign body (correct)

Infection without complications

Increased saliva production

Incorrect use of antihistamines

What is the causative organism of mumps?

Herpes simplex virus

Adenovirus

Paramyxovirus (correct)

Cytomegalovirus

What is the typical age range for mumps infections?

5 to 15 years Signup and view all the answers

Which of the following complications is NOT associated with mumps?

Acute bacterial parotitis Signup and view all the answers

What treatment can help alleviate symptoms of xerostomia?

Saliva substitutes Signup and view all the answers

What is a common infection associated with xerostomia?

Candidiasis Signup and view all the answers

What symptom follows the initial periauricular pain in mumps?

Painful swelling of the gland Signup and view all the answers

What is the primary characteristic of Sjogren's syndrome?

Lymphocytic infiltration and acinar destruction of salivary glands Signup and view all the answers

Which age group is most commonly affected by sialometaplasia?

Adults between 40-50 years Signup and view all the answers

What is the healing time for sialometaplasia?

8 weeks Signup and view all the answers

What is a common symptom of Primary Sjogren’s syndrome?

Xerostomia (dry mouth) Signup and view all the answers

What is a distinguishing feature of Secondary Sjogren’s syndrome?

It includes symptoms of dry mouth and dry eyes Signup and view all the answers

What should be performed to rule out malignant disease in the case of sialometaplasia?

Biopsy Signup and view all the answers

Which clinical feature is NOT associated with sialometaplasia?

Pain is common Signup and view all the answers

What is keratoconjunctivitis sicca associated with?

Dry eye condition Signup and view all the answers

What autoimmune disease involves the production of autoantibodies against the patient's own salivary gland tissue?

Sjogren syndrome Signup and view all the answers

At what age is Sjogren syndrome most commonly diagnosed?

50 years Signup and view all the answers

What is a common clinical feature seen in the oral manifestations of Sjogren syndrome?

Xerostomia Signup and view all the answers

Which test is used to measure the production of tears in diagnosing Sjogren syndrome?

Shrimer's test Signup and view all the answers

What ocular change is associated with Sjogren syndrome due to reduced tear production?

Keratoconjunctivitis sicca Signup and view all the answers

In Sjogren syndrome, the autoimmune attack primarily affects which type of glands?

Exocrine glands Signup and view all the answers

Which antibody is elevated in the serologic evidence of systemic autoimmunity associated with Sjogren syndrome?

Elevated rheumatoid factor Signup and view all the answers

What is a characteristic symptom of ocular changes in Sjogren syndrome?

Blurred vision Signup and view all the answers

What is a common symptom associated with bilateral parotid involvement?

Painful and swollen gland Signup and view all the answers

Which of the following best describes chronic bacterial sialadenitis?

A non-specific inflammatory disease due to ductal obstruction Signup and view all the answers

What is sialolithiasis?

The presence of calculi within the salivary ductal system Signup and view all the answers

Why does swelling and pain occur in the affected gland during mealtime in sialolithiasis?

Due to psychic stimulation of salivary flow Signup and view all the answers

Which anatomical feature contributes to the high incidence of stones in the submandibular gland?

Long and tortuous duct path Signup and view all the answers

What is the primary treatment approach for acute biliary parotitis?

Antibiotics and NSAIDs Signup and view all the answers

Which radiographic method is best for diagnosing stones in the submandibular gland?

Occlusal radiograph Signup and view all the answers

What histopathological feature is NOT typically associated with chronic bacterial sialadenitis?

Acinar hyperplasia Signup and view all the answers

What is one of the indications for postoperative adjuvant radiotherapy?

Facial nerve involvement Signup and view all the answers

Which chemotherapy agent has shown the most study in salivary gland cancers?

Cisplatin Signup and view all the answers

What is a potential side effect of Imatinib as mentioned in the content?

Significant toxicity Signup and view all the answers

What percentage of patients showed local control with palliative radiotherapy?

33% Signup and view all the answers

What molecular pathway is primarily associated with the inhibition of apoptosis?

EGFR/ErbB2 pathway Signup and view all the answers

What is the average response rate for Transtuzumab in incurable salivary gland cancer?

45% Signup and view all the answers

Which factor is used as a prognostic indicator in salivary gland cancer?

Age Signup and view all the answers

What is a common genetic alteration in adenoid cystic carcinoma?

C-Kit mutations Signup and view all the answers

Which therapy has shown efficacy in non-small cell lung cancer and colorectal cancer?

Cetuximab Signup and view all the answers

What role does the p53 gene function in relation to tumor development?

Arrests cell proliferation Signup and view all the answers

What characterizes Sjogren’s syndrome?

Intense lymphocytic infiltration of salivary glands Signup and view all the answers

Which treatment is suggested for xerostomia?

Artificial saliva Signup and view all the answers

What is the main cause of sialosis?

Hormonal disturbances Signup and view all the answers

What percentage of salivary gland neoplasms are malignant?

20% Signup and view all the answers

Which tumor type is most common in the parotid gland?

Pleomorphic adenoma Signup and view all the answers

In salivary gland tumors, pain is more frequently associated with which type?

Malignant tumors Signup and view all the answers

What is the impact of positive neck lymph nodes on survival?

Decreases ten-year survival from 63% to 33% Signup and view all the answers

Which imaging modality is considered gold standard for evaluating the duct system in salivary glands?

Sialography Signup and view all the answers

Which of the following is a benign salivary gland tumor?

Warthin’s tumor Signup and view all the answers

What could indicate a high risk of malignancy in a salivary gland tumor?

Pain upon palpation Signup and view all the answers

Which factor does NOT increase the risk of salivary gland tumors?

Regular oral hygiene Signup and view all the answers

What common symptom is associated with salivary gland tumors?

Asymptomatic swelling Signup and view all the answers

Which condition is specifically characterized by recurrent bilateral swelling of the salivary glands?

Sialosis Signup and view all the answers

What is indicated by the histological finding of epimyoepithelial islands?

Proliferation of ductal epithelium Signup and view all the answers

Study Notes

Salivary Gland Diseases

Salivary gland diseases are categorized into congenital abnormalities, variations in salivary flow, infectious conditions, tumor-like conditions, autoimmune conditions, sialosis, and tumors.

Congenital Abnormalities

Aplasia: Complete absence of one or more salivary glands, leading to xerostomia.
Atresia: Congenital absence or blockage of salivary gland ducts, leading to xerostomia and cyst formation.
Aberrancy: Normal salivary gland tissue developing in an abnormal location, like the Stafne bone defect.
- Stafne Bone Defect: A part of the submandibular gland can develop within a bony cavity or depression in the mandible. Typically discovered incidentally during X-ray examination. The defect appears as a well-defined area between the premolar region and the jaw angle, below the inferior dental canal.

Variation in Salivary Flow

Sialorrhea: Excessive salivation.
- Etiology : possible causes include acini hypertrophy, denture wear, certain medications (pilocarpine, iodides, bromides), teething in young children, and certain metal intoxications (lead, mercury, arsenic).
Xerostomia: Dry mouth due to decreased salivary flow.
- Etiology: possible causes include developmental problems (aplasia, atresia), endocrine abnormalities (menopause, hypothyroidism, diabetes), vitamin deficiencies (Vitamin A, C, B12, nicotinic acid), and anemias (pernicious, iron deficiency), and medication (antihistamines, anticholinergics, opium).

Clinical Manifestation of Sialorrhea & Xerostomia

Sialorrhea: Clinical signs include profuse salivation, metallic taste, painful and inflamed mucous membranes, and swollen salivary glands.
Xerostomia: Clinical signs include dry mouth, burning sensation, difficulty chewing and swallowing, speech difficulties, sloughing of mucous membranes, fissured tongue with atrophy of the filiform papillae, and unpleasant taste

Infectious Conditions

Viral:
- Mumps (acute epidemic parotitis) : An acute, contagious viral infection transmitted by droplets, causing parotid gland swelling.
- Cytomegalovirus inclusion disease:
- A rare condition caused by CMV, a herpes virus. CMV can remain latent in salivary gland cells. Reactivation is possible under conditions of weakened immunity. Congenital CMV infection can cause severe damage to babies.
Bacterial:
- Acute bacterial sialadenitis: Acute post-operative parotitis or surgical mumps infection, caused by microorganisms. Usually due to insufficient salivary flow.
- Chronic bacterial sialadenitis: Non-specific inflammation of major salivary glands due to ductal obstruction, leading to secondary pyogenic bacterial infection. Common cause is sialolithiasis(stone).
  - Mechanism: Sialolithiasis, a blockage of the salivary ducts by stones (calculi/sialoliths), leads to decreased salivary flow. This decreased flow creates an environment conducive to bacterial infection, which then causes chronic sialadenitis.

Sialolithiasis (Stones in Salivary Ducts)

Etiology: Caused by calcium salt deposition, altered mucin, epithelial cells, and bacteria. Submandibular glands are particularly affected (80%).
Factors include abnormally long, tortuous ducts (like Wharton’s duct in submandibular gland), thicker mucus secretions (rich in calcium), and possible food particle obstruction.

Clinical Picture of Sialolithiasis

Periodic swelling and pain, especially during mealtimes, due to the release of saliva.
In severe cases, a hard mass at the periphery of the duct can be felt.

Clinical Significance of Xerostomia

Infections (like candidiasis) are more common, related to a lack of saliva's protective and antimicrobial actions. This can lead to oral problems like gingivitis (inflammation of the gums), periodontitis, alveolar bone loss, and rampant caries (tooth decay).
Patients with xerostomia tend to experience annoyance and mouth-related discomfort.

Tumor-like Lesions (Necrotizing Sialometaplasia)

A benign inflammatory reaction in the salivary gland tissue, clinically and histologically resembling a salivary gland carcinoma (cancer). The cause is frequently related to local ischemia.

Autoimmune Condition (Sjogren's Syndrome)

A chronic, systemic autoimmune disorder causing lymphocytic infiltration and damage in the salivary glands. This results in dry mouth (xerostomia), dry eyes (xerophthalmia), and keratoconjunctivitis sicca (dry eye inflammation).

Salivary Gland Tumors

Epidemiology: Salivary gland neoplasms are uncommon, representing a small percentage of head and neck cancers. The most common location is the parotid gland. The majority are benign.
- Etiology: Environmental factors (alcohol, smoking, viral infections, radiation), dietary factors, and genetic factors play a role.
Presentation: Often asymptomatic swelling. Pain is not a common initial complaint.
Classification: Benign and malignant. Important parotid tumors: pleomorphic adenoma and Warthin's tumor (benign). Important malignant tumors: mucoepidermoid tumor, acinic cell carcinoma, and adenoid cystic carcinoma.

Diagnosis, Workup, and Imaging

US: Initial assessment tool. Good for evaluating superficial areas, but less effective for deep-lobe conditions.
Sialography: Gold standard for evaluating the duct system to ensure normal flow in salivary ducts and visualize any obstructions.
CT Scan: Modality of choice for suspected inflammatory disorders, visualization of salivary duct stones, cortical bone involvement, and signs of necrosis in tumors (important for distinguishing benign from malignant, or for identifying deep-seated lesions).
MRI: Modality of choice for palpable lesions or suspected cancers. More detail on soft tissue, useful to rule out intracranial extensions or lymph node involvement.
PET/CT Scan: Improved staging for evaluating cancers, especially when tumors are already treated.
Fine-Needle Aspiration Biopsy (FNAB): Screening biopsy to differentiate inflammatory cells from cancerous cells to assist diagnosis . It’s less invasive than other biopsies, allowing for detection of inflammatory cells versus malignant cells.

Treatment

Benign parotid tumors: Often require enucleation (removal of the growth) or superficial parotidectomy (removal of part of the parotid gland). Large tumors or those affecting deeper lobes might require total parotidectomy.
Malignant parotid tumors and submandibular tumors: Often require comprehensive surgical resection (removal) involving the entire affected tissue or gland. In some cases, wider surgical procedures (like total parotidectomy) are performed. High-grade cancers may necessitate wide surgical margins, and preservation of facial nerves is a paramount concern.

Management of the Neck

Node-positive neck: Patients with ipsilateral (same side) lymph nodes (LN) positive for tumor: ipsilateral radical neck dissection (removal of lymph nodes on the affected side of the head and neck). If contralateral (opposite side) nodes are also affected, a contralateral modified neck dissection is performed to preserve the internal jugular vein.

Radiotherapy

Indications: High-grade or unfavorable histology, advanced clinical stage, involvement of facial nerves, or positive margins of resection or neck nodes following surgery.
Purpose: To prevent recurrence of tumor growth in surrounding tissues and reduce regional spread of the tumor to surrounding areas.

Chemotherapy

Role is often limited to treatment of metastatic disease or to palliative care for aggressive, loco-regional disease when surgery or radiation therapy are not appropriate treatment choices. Cisplatin is the most studied single agent for this purpose.

Molecular Targeted Therapy

Purpose: Identify molecular abnormalities in different subtypes of salivary gland cancers allowing for targeted therapies.

Biopsy Considerations

Fine-needle aspiration biopsy (FNAB): Provides an initial, less invasive method for screening.
Disadvantage: Inaccurate in differentiating between certain types of tumors.

Other Considerations

A summary of other possible treatment approaches may exist elsewhere in these notes (e.g., excisional biopsy).
Information on special cases or complications of these procedures might also be relevant.

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Description

Test your knowledge on xerostomia and mumps with this quiz. Explore significant clinical features, complications, and treatment options regarding these conditions. Ideal for students and professionals in the medical and dental fields.