In the mouth!
linea alba = noun, a normal variation in the buccal mucosa that appears as a white line beginning at the corners of the oral cavity and extending posteriorly at the level of the occlusal plane. It is composed of keratinized oral mucosa.
What three systemic conditions are indicated by the color of the oral mucosa?
anemia, cyanosis, and jaundice
(red, blue, and yellow)
Which parts of the oral mucosa are not keratinized?
inside the cheeks, sides of the tongue, the soft palate and the floor
(keratinized: facial aspect of lips, dorsum of tongue, gingiva around teeth roots, hard palate
What symptom can be caused by mouth breathing, dehydration, diuretics, salivary disease or sialoliths?
recurrent herpes labialis = painful blisters on lip due to HSV, prodrome lasts 12-36 hours followed by vesicular eruption along vermillion border that rupture, ulcerate and crust. Triggered by UV, trauma, fatigue, stress, menstruation
angioedema = acute dema of the skin, mucosa & submucosal tissue around mouth/tongue and/or throat, also hands, swelling may continue for minutes or hours. Can be itchy and have reduced sensation dt nerve compression. Urticaria may develoop simultaneously if the angioedemia is related to allergy. ETIO: allergic stimulation but not IgE mediated (meds, food, pollen, pet dander, insect bites), exposure to water, sunlight, cold/heat, emotional stress, after infections or illness incl autoimmune disorders, leukemia and more. Can lead to airway obstruction and death dt laryngeal edema (anaphylaxis?).
hereditary angioedema = inherited deficiency of C1 esterase inhibitor in 85%, rare, autosomal dominant. Different from regular angioedema: painful not pruritic, no urticaria, idiopathic, may incl abdominal pain "attacks", usu w/ intense vomiting, weakness, diarrhea, and an unraised, non-itchy splotchy/swirly rash
angular cheilitis = inflam lesion at labial commissuyre, often bilateral, crack/split may bleed, may crust, etc. ETIO: nutritional deficiency esp B2 riboflavin and B12 cyanocobalamin, and iron, secondary infx by candida etc, as part of Plummer-Vinson syndrome (upper esophageal web, iron deficient anema, glossitis, cheilosis), being old with lots of lip overlap, kids who lick lips habitually.
SCC = squamous cell cancer, usu found at mucocutaneousjunction of lips, more common on the lower lip, painless, sharply demarcated, elevated, indurated border with ulcerated base, may be verrucous or plaque-like, high risk factors include chronic smoking and alcohol intake.
chancre = painless ulceration formed during the primary stage of syphilis, about 3 weeks after initial exposure to Treponema pallidum, located on/around anus, mouth, penis/vagina, diminish in a few weeks without treatment
lichen planus = a thready/lacy white or gray network of papules on buccal mucosa or tongue, preceding eruption of purple polygonal pruritic papules with white lines/spots, usu on genitalia, lower back, ankles and lower anterior legs, priruts, nails have longitudinal ridges, alopecia.
frictional hyperkeratosis = white lesion from long term trauma ie from dentures, may see linea alba, consider idiopathic leukoplakia
denture sore spots, denture sore mouth = very common from ill-fitting appliances, severe burning sensation is common, sharply delineated redness where dentures contact differentiates from erythroplakia, may be fungal, may heal when mouth is allowed to rest without dentures
irritation fibroma = most common benign oral soft tissue neoplasm, any age but most 20-49 years, often traumatized buccal mucosa, lateral tongue border and lower lip, painless, lighter than healthy mucosa, sessile or occasionally pedunculated swelling that can be firm and resilient or soft and spongy in consistency, may ulcerate, rarely over 1cm diameter
fordyce's granules = ectopic collection of sebaceous glands at various sites in the oral cavity, multiple, often occurring in aggregate or in a confluent arrangement, 20-30 years, M=F, usu bilat symmetric on buccal mucosa opposite molar teeth, also on inner lips, retromolar region, tongue, gingiva, frenum and palate, cause not known, check for candida by trying to wipe it off
sialadenitis = painless benign swelling of salivary glands, seen in many systemic dzs (hepatic cirrhosis, sarcoidosis, neoplasms, infx), usu painful with mumps, malignancy and infection, others may be painless.
sialolisthesis = salivery duct stones, usu in submandibular glands, pain and swelling assoc w/ eating
stomatitis = inflam of oral tissue, ETIO: infx, avitaminosis (B&C), iron deficiency anemia wiht dysphagia, leukemia, agranulocytosis, mechanical trauma (dentures, nipples on bottles), xerostomia (drugs, radiation, aging), alcohol, tobacco, hot/spicy foods and drinks, mouth breathing, cheek biting, jagged teeth, chemical stomatitis, mercury poinsoning with market salivation, allergy)
gingivitis = gum inflam dt poor oral hygiene, malocclusion, dental calculi, food impaction, faulty dnetal restorations, mouth breathing, common in puberty and during pregnancy. Gums painless except when pressure applied, bleed easily, may be red or purple or shiny or swollen, may itch may not, receding gum line, may be 1st sign of DM, poor nutrition, endocrine disorders, leucopenia, etc. Dilantin (for seizures) can cause enlargment of the gums.
vincent's angina = trenchmouth or ulcertaing necrotizing gingivitis = what happens if you don't fix your gingivitis, ETIO: fusiform bacteria and spirochetes, bad oral hygienze, severe stress, malnutrition, much more with alcohol & tobacco use
thrush = oral candida infx, white curdy plaque that can be wiped off, most in debilitated/elderly people, with longterm antibiotics/steroids, with xerostomia and in infants.
pseudomembranous stomatitis = inflam rxn w/ exudates dt chem irritants or bact infx
apthous stomatitis = canker sores, acute, painful, recurring, solitary or multiple necrotizing ulcerations of oral mucosa. May suggest glutn sensitivity, autoimmune dz (SLE), crohn's dz. Triggers: trauma, food allergy, citric acid, artifical sugars, gluten, stress, hormones, weight loss, foaming toothpaste (sodium lauryl sulfate, B12/folic acid/iron deficiency, illness, fatigue...types: minor, major, herpetiform
oral herpes gingivostomatitis = painful eruptions of oral mucosa dn vermillion border, usu in kids wtih feeding problems, initial eruption most severe, consider: apthous stomatitis, erythema multiforme, drug eruptions, rarely pemphigus
oral erythem multiforme = painful with sudden onset of diffuse hemorrhagic veicles and bullae on lips and mucosa, systemi sx: erythematous macules nad papules form symmetrically on hands, arms feet, legs, face, neck, and possibly in eyes and on genitalia, prodrome: sinusitis, rhinitis, multiple vesilces, may have high fever 4-5 days. DDX: apthous stomatitis, allergic stomatitis, pemphigus, herpes
leukoplakia = nonspecific white patch on oral mucosa that cannot be rubbed off, dt tobacco, alcohol, vitamin deficient, dental galvanism!!!
oral squamous cell carcinoma = 90% of victims are smokers, alcohol is also a risk factor, diet too. 40% begin on the floor of the mouth or on the lateral and ventral surfaces of the tongue, 38% on the lower lip, 11% begin in the palate and tonsillar area. early, curable lesions are rarely symptomatic. May appear in areas of erythroplakia or leukoplakia and may be exophytic or ulcerated, both are indurated and firm with a rolled border. Metastatic mass in neck may be 1st symptom.
palatial or mandibular torus = non-neoplastic, slow growing nodule of bone, interferes with dentures, probably hereditary, more in females just before 30.
papillomas = asymptomatic, well-circumscribed, usu pedunculated growths with numerous tiny fingerlike projections
miasm types (5): soric (the great eliminator), psychotic, syphilitic (poor eliminator, addictions/self-destruction), tuberculinic (poor eliminator, high paroxysmal fevers)
epulis fissura = denture-induced fibrous hyperplasia, overgrowth of tissue, defensive, usu in vestibular mucosa
varicosities = duh
hairy tongue = black or green hyperplasia of filiform papillae, dt coffe, tobacco, aids, mouthwash, prednisone/estrogen use, antibiotics, dyes in food, candida etc
glossitis = smooth tongue, "beefy" red or pale if anemic or "fiery" red if B vit deficient, shiny, poss swollen, burning, may have trouble eating/drinking, suspect macrocytic or pernicious anemia, iron deficiency, cirrhosis, B complex deficiency, low HCl/post gastrectomy, erythema multiforme, syphilis, oral lichen planus, pemphigus, etc etc etc
What causes 90% of pharyngitis?
what can cause the tongue to enlarge: acromegaly, amyloidosis, angioedema, allergic rxn
What four factors make you suspect that pharyngitis might be bacterial:
2) swollen LN's
with all four there's a 50% chance it's bacterial
tonsilitis, perisonsillar abscess (quinsy), tonsilloliths