Oral Pathology Quiz

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Questions and Answers

What is a key distinguishing feature of leukoplakia?

It can be easily removed by rubbing.

It presents as a white patch on oral mucosa. (correct)

It resolves with olive oil application.

It is only found in patients with diabetes.

What is typically the initial diagnostic step if a leukoplakia lesion is enlarging or ulcerating?

Prescribe antifungal medication.

Immediate surgical excision.

Clinical observation for six months.

Incisional biopsy or exfoliative cytologic examination. (correct)

Erythroplakia is primarily associated with what potential diagnosis?

Chronic irritation.

Allergic reactions.

Bacterial infections.

Dysplastic changes or carcinoma. (correct)

What treatment modalities are recognized for leukoplakia?

Surgical excision, laser ablation, cryotherapy, and retinoids. (A) Signup and view all the answers

Which condition is typically represented as a white patch on the mucosal surface in the oral cavity?

Leukoplakia. (A) Signup and view all the answers

What is the main clinical feature that sets leukoplakia apart from similar oral lesions?

Cannot be removed by rubbing. (A) Signup and view all the answers

Which bacterium is most commonly associated with sialadenitis?

Staphylococcus aureus (C) Signup and view all the answers

What primary physiological condition may lead to sialadenitis via ductal obstruction?

Severe dehydration (D) Signup and view all the answers

Which duct does the parotid gland drain through?

Stensen's Duct (D) Signup and view all the answers

What is a common clinical feature of sialadenitis?

Acute gland swelling and pain (B) Signup and view all the answers

Which factor is most likely to contribute to the formation of calculi in sialolithiasis?

Dehydration and increased calcium levels (D) Signup and view all the answers

What is the primary etiological agent of oral candidiasis?

Candida albicans (A) Signup and view all the answers

Which condition is NOT a risk factor for developing oral candidiasis?

Hypertension (A) Signup and view all the answers

What is a common clinical feature of pseudomembranous candidiasis?

Creamy-white curd-like plaques (B) Signup and view all the answers

Which treatment option is specifically recommended for oral candidiasis?

Nystatin swish & swallow (D) Signup and view all the answers

What kind of dental plaque is primarily responsible for gingivitis?

Bacterial biofilm (D) Signup and view all the answers

What is an identifiable symptom of gingivitis?

Easily bleeding gums (B) Signup and view all the answers

Which of the following conditions can lead to periodontitis from gingivitis?

Cancer treatment (D) Signup and view all the answers

What characteristic change occurs in healthy gingiva during gingivitis?

Becomes easily bleeding upon flossing (A) Signup and view all the answers

Which treatment is NOT included for managing oral candidiasis?

Antibiotics such as amoxicillin (B) Signup and view all the answers

Which factor is NOT typically associated with the etiology of glossitis?

Emotional stress (C) Signup and view all the answers

What is a primary characteristic of the tongue presentation in glossitis?

Red, smooth surface (B) Signup and view all the answers

Which of the following is true regarding aphthous ulcers?

They appear as painful, round ulcerations. (D) Signup and view all the answers

What is the initial treatment for herpes stomatitis?

Self-limiting management (C) Signup and view all the answers

In which location are lesions from herpes stomatitis most commonly found?

Attached gingiva and lip junction (B) Signup and view all the answers

What is the likely pathophysiological trigger for aphthous ulcers?

Trauma or stress (B) Signup and view all the answers

What characterizes the pain associated with glossitis?

Glossodynia can occur (B) Signup and view all the answers

Which medication is used to decrease the duration of herpes stomatitis?

Acyclovir (B) Signup and view all the answers

What symptom is typically associated with herpes stomatitis in immunocompromised patients?

Frequent recurrence and severity of lesions (B) Signup and view all the answers

In glossitis diagnosis, which approach is primarily used?

Clinical diagnosis (A) Signup and view all the answers

What is the common name for Necrotizing ulcerative gingivitis?

Trench Mouth (C) Signup and view all the answers

Which of the following is NOT a symptom of Necrotizing ulcerative gingivitis?

Tooth Decay (D) Signup and view all the answers

What is the primary prevention method for gingivitis?

Preventing plaque buildup (D) Signup and view all the answers

What is the role of radiographs in gingivitis diagnosis?

They are used to detect periodontal disease, which can be a contributing factor. (C) Signup and view all the answers

What is the primary treatment method for gingivitis?

Debridement by dental professional and oral hygiene routine at home (B) Signup and view all the answers

What is the main treatment modality for Necrotizing ulcerative periodontitis?

All of the above (D) Signup and view all the answers

Which of the following is NOT commonly used in treating Necrotizing ulcerative periodontitis?

Dental implants (B) Signup and view all the answers

What is a common characteristic of Necrotizing ulcerative periodontitis?

Rapid attachment and bone loss (C) Signup and view all the answers

What is the significance of the patient's HIV-positive status in this case?

HIV-positive patients are more susceptible to severe periodontal disease (B) Signup and view all the answers

What is the key takeaway from the case described in the content?

Necrotizing ulcerative periodontitis can cause significant tissue damage and require multi-modal treatment (A) Signup and view all the answers

What is the etiology of leukoplakia?

Chronic irritation (A) Signup and view all the answers

What are the signs of leukoplakia? (Select all that apply)

White Patch (A) Signup and view all the answers

What is the first line treatment for leukoplakia?

Surgical Excision (A) Signup and view all the answers

What is the etiology of erythroplakia?

Dysplastic or carcinoma (A) Signup and view all the answers

Which of the following are clinical features of Erythroplakia? (Select all that apply)

Erythematous patch (A), Fiery red, sharply demarcated (D) Signup and view all the answers

What is the pathophysiology of oral lichen planus?

T-cell mediated autoimmunity involving epithelial cells (A) Signup and view all the answers

Which of the following is a clinical feature of oral lichen planus?

It presents as lacy leukoplakia (A) Signup and view all the answers

What is the first line treatment for oral lichen planus?

Topical corticosteroids (A) Signup and view all the answers

What is the etiology of Oral Candidiasis?

Candida albicans (A) Signup and view all the answers

What is the pathophysiology of oral candidiasis?

Immune suppression resulting in fungal overgrowth. (A) Signup and view all the answers

What are the clinical features of oral candidiasis? (Select all that apply)

White patches on oral mucosa (A), Red, swollen gums (B), Burning sensation in the mouth (C), Easily removed with tongue depressor (@) Signup and view all the answers

What are treatments for oral candidiasis? (Select all that apply)

Nystatin swish and swallow (A), Fluconazole (B) Signup and view all the answers

What is the etiology of gingivitis?

Bacterial biofilm (A), Poor oral hygiene (C) Signup and view all the answers

Necrotizing ulcerative periodontitis is commonly seen in?

Patients with HIV (B) Signup and view all the answers

What is a common etiology of glossitis?

Vitamin B deficiency (A) Signup and view all the answers

What is a common pathophysiological feature of glossitis?

Loss of filiform papillae (A) Signup and view all the answers

What are some clinical features of glossitis? (Select all that apply)

Swelling of the tongue (A), Red, smooth surface (B), Loss of papillae (C) Signup and view all the answers

What is a key treatment for glossitis?

Vitamin B12 supplementation (B) Signup and view all the answers

What are the potential etiologies of aphthous ulcers? (Select all that apply)

Association with HHV 6 (C) Signup and view all the answers

Which of the following are clinical features of aphthous ulcers? (Select all that apply)

Painful lesions (A), Yellow or gray lesions with a red halo (C) Signup and view all the answers

What are the clinical features of herpes stomatitis? (Select all that apply)

Vesicular lesions (A), Initial burning (B), Swollen lymph nodes (C) Signup and view all the answers

Which of the following is a common etiology of sialadenitis?

Staphylococcus aureus (A) Signup and view all the answers

Which of the following are clinical features of sialadenitis? (Select all that apply)

Gland swelling and pain (A), Dry mouth (B), Fever (C) Signup and view all the answers

What is sialadenitis?

An inflammation of the salivary glands (A) Signup and view all the answers

Parotid gland drains via what duct?

Stensen's duct (B) Signup and view all the answers

Submandibular and sublingual glands drain via what duct?

Wharton’s duct (B) Signup and view all the answers

What is the first line treatment for sialadenitis?

IV/PO Abx (A) Signup and view all the answers

What is a common etiology of sialolithiasis?

Stagnation of salivary flow (A), Increasing calcium levels in saliva (D) Signup and view all the answers

Which of the following are clinical features of sialolithiasis? (Select all that apply)

Postprandial pain (A), Swelling of the gland (B), Dry mouth (C) Signup and view all the answers

Which of the following are treatments for sialolithiasis? (Select all that apply)

Surgical removal of the stone (B), Sialagogues to promote saliva flow (C) Signup and view all the answers

What is the most common salivary gland tumor?

Pleomorphic adenoma (A) Signup and view all the answers

What is the most common location for a salivary gland tumor?

Parotid gland (A) Signup and view all the answers

What is a primary etiology of Sjögren's syndrome?

Autoimmune dysfunction (B) Signup and view all the answers

Which of the following clinical features are associated with Sjögren's syndrome? (Select all that apply)

Dry eyes (A), Dry mouth (B) Signup and view all the answers

What is the primary pathophysiological mechanism of Sjögren's Syndrome?

Immune dysfunction of lacrimal and salivary glands (A) Signup and view all the answers

Which of the following tests are used in the diagnosis of Sjögren's syndrome? (Select all that apply)

Rheumatoid factor (A), Schirmer test (B) Signup and view all the answers

What is the primary etiology of Mumps/Parotitis?

Paramyxovirus (B) Signup and view all the answers

Which of the following are clinical features of mumps? (Select all that apply)

Painful, swollen salivary glands (A), Fever (B) Signup and view all the answers

Study Notes

Oral Cavity Disorders

The presentation covers various oral cavity disorders, emphasizing etiology, pathophysiology, clinical features, diagnosis, complications, and treatment.

Objectives

Summarize the etiology, pathophysiology, clinical characteristics, diagnostic methods, potential complications, and treatments for listed conditions.

Leukoplakia: Etiology & Pathophysiology

Etiology includes chronic irritation (dentures, tobacco, lichen planus).
In rare cases (2-6%), it can be dysplastic or early invasive carcinoma.
Pathophysiology involves a hyperkeratotic response.
A potential rare malignancy is present.

Leukoplakia: Clinical Features

Characterized by a white patch on the oral mucosa, not removable via rubbing.
Differentiates leukoplakia from other conditions.
Ranges in size from small to several centimeters.

Leukoplakia: Diagnosis & Treatment

A complete oral cavity exam is essential.
If friction factors (dentures) resolve the issue, it is not leukoplakia.
Early referral to a specialist for diagnosis and treatment is needed.
If the lesion enlarges, ulcerates, or exhibits submucosal depth, biopsy is required.
Treatment options include surgical excision, laser ablation, cryotherapy, retinoids, and watchful waiting.
Images of different stages of leukoplakia biopsy procedure are also present.

Erythroplakia: Etiology & Pathophysiology

90% cases are dysplastic or carcinoma.
Important to differentiate from leukoplakia.
Pathophysiology includes dysplastic changes leading to malignant responses, commonly in older tobacco or alcohol users.

Erythroplakia: Clinical Features

Similar to leukoplakia, exhibiting an erythematous component.
Fiery red, sharply demarcated patches on the oral mucosa.

Erythroplakia: Diagnosis & Treatment

Comprehensive HEENT exam, including lymph node checking (fine needle aspiration is a quick diagnostic method).
All lesions require biopsy.
Treatment involves surgical excision with clear margins, or potential laser therapy with higher recurrence rates.

Recall Check: Lichen Planus

Pruritic, flat-topped papules with irregular angulated borders (purple, polygonal) are primary characteristics.
Primarily affects scalp, extremities, nails, and mucous membranes.
New lesions appear pink or white, exhibiting a classic lacy reticulated pattern.
Lesions can develop at the injury site.
There are 5 Ps to recall for this condition.

Oral Lichen Planus: Etiology & Pathophysiology

The etiology is autoimmune in nature.
It is a chronic inflammatory disorder with an immune reaction.
The reaction targets epithelial cells.
Mucosal lesions often are white lacy or erosive and frequently occur on the buccal mucosa, tongue, and lip; rarely beyond the vermillion border, or involving the genitalia.

Oral Lichen Planus: Clinical Features

Often presents as lacy leukoplakia, but can manifest as erosive conditions.
Reticular, erythematous, and erosive subtypes are possible.
Can coexist with other types of extraoral lichen planus.

Oral Lichen Planus: Diagnosis & Treatment

Definitive diagnosis typically requires biopsy.
A classic reticular pattern might be clinically diagnosed.
Topical corticosteroids are a first-line treatment.
Potential complications of the treatment need exploration.
Maintaining good oral hygiene is vital and minimizing irritants is crucial.

Oral Candidiasis: Etiology & Pathophysiology

Etiology: Candida albicans.
Pathophysiology: Characterized by fungal overgrowth in cases of immune suppression.
Associated risk factors include dentures, poor oral hygiene, diabetes mellitus, anemia, chemotherapy, corticosteroid use, and antibiotic use, particularly in infants.

Oral Candidiasis: Clinical Features

Presents as creamy-white, curd-like plaques.
An erythematous oral cavity.
Fluctuating throat or mouth discomfort.
Possible alteration in taste perception.
Plaques are easily removed by a tongue depressor.

Oral Candidiasis: Diagnosis & Treatment

Diagnosis is typically clinical.
Potassium hydroxide (KOH) wet prep is a potential supporting diagnostic method.
Treatment options include topical nystatin swish and swallow, or oral antifungals (e.g., fluconazole).
Addressing underlying conditions (e.g., managing diabetes) is crucial for treatment effectiveness.
Maintaining good oral hygiene is essential.

Gingivitis: Etiology & Pathophysiology

Primarily due to bacterial biofilm (dental plaque).
Other contributing factors include pregnancy, vitamin C deficiency, drug-induced situations, and necrotizing diseases.
Dental plaque progression can lead to gingivitis or periodontitis

Gingivitis: Clinical Features

Healthy gingiva is typically pink, firm, and without recession.
Gingivitis manifests as red, swollen, and easily bleeding tissues, particularly with flossing or brushing.
Periodontitis is an advanced form characterized by gingival inflammation and loss of supportive connective tissue.

Gingivitis: Diagnosis & Treatment

Diagnosis is typically clinical.
Radiographs are potentially used to diagnose periodontal disease.
Prevention focuses on preventing plaque build-up.
Treatment involves professional debridement combined with home oral hygiene practices.
Chlorhexidine mouthwashes are a part of the treatment routine.

Gingivitis: Other Causes

Necrotizing ulcerative gingivitis (Trench Mouth) involves painful acute inflammation and necrosis, frequently associated with bleeding and halitosis (bad breath).
Fever and cervical lymphadenopathy may be present.
Necrotizing ulcerative periodontitis is a common complication in HIV patients, marked by rapid attachment loss and bone loss.

Glossitis: Etiology & Pathophysiology

Etiology encompasses nutritional deficiencies, drug reactions, dehydration, and autoimmune disorders.
Pathophysiology includes inflammation of the tongue, leading to the loss of filiform papillae.

Glossitis: Clinical Features

A characteristic presentation is a red, smooth-surfaced tongue.
It can sometimes be painful (glossodynia), manifesting as burning or pain.
Geographic tongue might also be a feature.

Glossitis: Diagnosis & Treatment

Diagnosis is largely clinical.
Biopsy may be required in certain scenarios.
Treatment targets the underlying cause of the inflammation.
Nutritional consultation and potential nutritional replacement therapies are vital.

Intraoral Ulcers: Etiology & Pathophysiology

Aphthous ulcers (canker sores) have an unknown etiology, potentially associated with Human Herpesvirus-6 (HHV-6).
Herpes stomatitis is associated with herpes simplex virus (HSV) infection, residing dormant in trigeminal nerve ganglia and reactivating.
Trauma and stress can be contributory factors in aphthous ulcer development.

Intraoral Ulcers: Clinical Features

Aphthous ulcers manifest as shallow, painful, round ulcerations with a yellow-gray center and a red halo.
They typically affect the non-keratinized oral mucosa (e.g., buccal mucosa, rather than gingiva or palate).
Recurrent cases are frequently encountered.
Herpes stomatitis presents with mild initial burning progressing to lesions. They typically appear in the attached gingiva and lip junctions, but can be found anywhere on the oral mucosa.

Intraoral Ulcers: Diagnosis & Treatment

Diagnosis is largely clinical.
Treatment for aphthous ulcers is often self-limiting; however, for sizable and debilitating cases, topical or oral steroids might be considered.
Treatment for herpes stomatitis typically involves antiviral medications (e.g., acyclovir, valacyclovir).
The aim is to reduce pain duration and prevent postherpetic neuralgia.

Sialadenitis: Etiology & Pathophysiology

Bacterial infection is the most common cause, with Staphylococcus aureus being the most frequent culprit.
Dehydration or chronic illness (e.g., Sjogren's syndrome) may predispose to ductal obstruction through mucus plugs.
The mucus plug buildup then leads to secondary infection.

Sialadenitis: Clinical Features

Swollen salivary glands.
The salivary glands, especially the parotid or submandibular, are affected.
Swelling and pain are hallmarks.
Physical examination (PE), especially tenderness and erythema are observed.
Pus from the gland might be expressed upon massage.

Sialadenitis: Diagnosis & Treatment

Diagnosis is mainly clinical.
Ultrasound (US) or computed tomography (CT) imaging may be helpful when clinical improvement isn't observed.
Treatment typically includes intravenous (IV) or oral antibiotics.
Increasing salivary flow support is part of the treatment protocol and includes hydration, warm compresses, and sialogogues (e.g., lemon drops).

Sialolithiasis: Etiology & Pathophysiology

Sialolithiasis, or salivary gland stones, have a complex etiology that isn't fully understood but is tied to salivary flow stagnation, and possible higher calcium levels.
Secondary development of calculi may arise from inflammation, injury, and bacteria.

Sialolithiasis: Clinical Features

Post-meal pain and swelling are hallmark characteristics.
Painless swelling may be involved too.
A physical examination (PE) may help visualize or palpate the stone(s).

Sialolithiasis: Diagnosis & Treatment

Diagnosis is typically clinical.
Imaging tests (e.g., ultrasound or CT) may be performed to confirm the presence and location of stones.
Treatment strategies revolve around HEENT referrals.
Removal strategies could be physical dilation of the duct or surgical removal of the stone, depending on its accessibility.
Distal stones may require endoscopic procedures (e.g., sialoendoscopy).

Salivary Gland Tumors: Etiology & Pathophysiology

No single definitive cause is present.
Risk factors include exposure to radiation, smoking, viral infections (EBV, HIV, HPV), and various environmental influences.
The vast majority of salivary gland tumors are benign and are usually located in the parotid gland..

Salivary Gland Tumors: Clinical Features

Often present as asymptomatic masses in the superficial gland tissue.
If the facial nerve is involved, symptoms dependent on facial nerves will be manifest.

Salivary Gland Tumors: Diagnosis & Treatment

CT/MRI are now replacing sialography.
Fine needle aspiration (FNA) biopsy is a common diagnostic tool.
Treatment approaches involve parotidectomy (or submandibular gland excision), potentially foregoing FNA in specific instances for faster surgical management.
Postoperative radiation might be necessary if the tumor is high-grade malignancy.

Sjogren's Syndrome: Etiology & Pathophysiology

It is a systemic autoimmune disorder.
Middle-aged females are the most commonly affected population.
Pathophysiology centers on impaired function of lacrimal and salivary glands.
Sjogren's can be primary, meaning it is the only problem occurring, or secondary, meaning it is associated with another rheumatic condition.

Sjogren's Syndrome: Clinical Features

The core symptoms are dry eyes and dry mouth.
Ocular symptoms can involve burning, itching, foreign body sensation, and difficulties with contact lenses.
Xerostomia, or dry mouth, causes difficulties with swallowing dry foods and raises the risk of dental cavities.
Systemic involvement can include related conditions or rheumatoid arthritis.
Dryness can affect additional anatomical regions, including the nose, throat, larynx, bronchi, vagina, and skin.

Sjogren's Syndrome: Diagnosis & Treatment

Diagnosis often involves rheumatic factor and antinuclear antibodies (ANAs).
A Schirmer test is standard for measuring tear secretion.
Complete blood count (CBC) assists in evaluating systemic activity.
Biopsies of the salivary glands, specifically lymph nodes in accessory salivary glands, are sometimes needed.
Treatment primarily focuses on alleviating symptoms and preventing complications from the related conditions or other systemic manifestations.

Mumps/Parotitis: Etiology & Pathophysiology

The etiologic agent is Paramyxovirus, affecting salivary glands via respiratory droplet spread.
Incubation time for these symptoms is about 12-15 days.
It is contagious and spreads rapidly in congregate settings.
A significant portion of the cases of this disease are subclinical, meaning they do not exhibit the typical symptoms.

Mumps/Parotitis: Clinical Features

Classic presentation is painful and swollen salivary glands (chiefly the parotid glands).
Secondary symptoms, such as facial weakness, trismus (difficulty opening the jaw), and less commonly, involvement of the pancreas and meninges might be observed.
Physical examination (PE) often reveals tenderness of the parotid region with accompanying facial edema.

Mumps/Parotitis: Diagnosis & Treatment

Diagnosis is primarily based on clinical findings.
Elevated levels of IgM antibodies are indicative of infection.
Mild leukopenia and lymphocytosis are also possible blood chemistry findings.
Symptomatic management includes topical compresses, antipyretics, and supportive care.
Effective prevention is by vaccination with MMR (measles, mumps, rubella).
Patients should be isolated until the swelling subsides.

Diseases of Oral Cavity and Pharynx (Summary Table)

A table providing a summary of various oral cavity and pharynx diseases, outlining their etiology, pathophysiology, clinical manifestations, diagnosis, and management approaches.

Case 1

A new graduate physician assistant (PA) presents with persistent, worsening left lower jaw swelling and trismus, after taking Benadryl.
Considerations for diagnosis and the relevance of the work history are presented, along with questions pertaining to the overnight worsening of the condition.

Case 2

A patient recovering from a superficial parotidectomy presents for ongoing monitoring.
Neurological examination approach and potential deficit sites to asses due to the surgery are explored.

Board Question

A 4-year-old with sore throat, fever, rash, and concerning skin manifestations requires differential diagnosis from common childhood illnesses like Kawasaki's disease, scarlet fever, rubella, and rubeola.

Review

Discussion about differentiating conditions that can lead to malignancy (leukoplakia vs. erythroplakia).
Differentiating modalities for oral diagnosis and the examination techniques used.
Differentiating common oral disorders (aphthous ulcers vs. herpes stomatitis).
Key differences and distinction between sialadenitis and sialolithiasis are also reviewed.

Studying That Suits You

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Description

Test your knowledge on oral pathology, particularly focusing on conditions like leukoplakia, sialadenitis, and oral candidiasis. This quiz covers key features, diagnostic steps, and treatment modalities associated with these lesions. Perfect for students in dental and medical fields.