| Diseases of the teeth and gums (ReelDx) |
Gingivitis: patient should be counseled about increases risk for cardiovascular events
Gingival Hyperplasia: Overgrowing of gums so that it blocks the teeth, commonly caused by medications. phenytoin, CCB's and cyclosporine
Vincent's Angina: “Trench Mouth” necrotizing gingivitis: characterized by the “punched-out” appearance of the gingival papillae
Dental abscess: Poor dental health is a risk factor for a dental abscess or facial cellulitis, treat with IM ceftriaxone and amoxicillin |
| Aphthous ulcers |
Single or multiple small, shallow ulcers with a yellow-gray fibrinoid center with red halos, a biopsy should be considered for ulcers lasting more than 3 weeks
TX: viscous lidocaine 2–5% applied to ulcer QID after meals until healed |
Candidiasis
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Immunocompromised, young patients
- Painful, white fluffy patches that can be scraped off and may bleed when scraped (candidiasis can "come off") leaving an erythematous, friable base
- Potassium Hydroxide (KOH) prep for diagnosis
TX: Antifungals, which are available in several forms (i.e., ketoconazole or fluconazole orally, clotrimazole troches, nystatin liquid rinses) |
| Deep neck infection |
Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, deep cervical lymph nodes, middle ear, or sinuses
- Classic manifestations of these infections include high fever, systemic toxicity, and local signs of erythema, edema, and fluctuance
- Computed tomography (CT) is the imaging modality of choice for the diagnosis of deep neck space infection
- The most common organisms isolated from deep neck space infections are viridans streptococci
TX: Antibiotics, aspiration or surgical drainage should be performed |
| Epiglottitis |
Unvaccinated patient leaning forward, drooling, stridor and distress (tripod position, muffled voice)
TX: Secure airway, admit, IV Ceftriaxone, and IV fluids |
| Herpes simplex |
HSV type 1, vesicular lesions all in the same stage of development, a prodromal period of tingling discomfort or itching
TX: Symptomatic treatment with antipyretics and analgesia is recommended. IV hydration is sometimes needed in cases of decreased oral intake
- Oral acyclovir (15 mg/kg/dose five times per day for 7–10 days; max 200 mg per dose) may decrease the duration of illness if started within 72 hours at the onset of symptoms
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| Laryngitis |
Almost always viral, hoarseness following a URI
- Consider squamous cell carcinoma if hoarseness persists > 2 weeks, history of ETOH and or smoking, laryngoscopy is required for symptoms persisting > 3 weeks
TX: Relax voice, supportive
- Oral or IM corticosteroids may also hasten recovery for performers but requires vocal fold evaluation before starting therapy
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| Peritonsillar abscess |
Presents with a severe sore throat, lateral uvula displacement, bulging tonsillar pillar
- Hot potato (muffled) voice and deviation of the uvula to one side
- + Streptococcus pyogenes
TX: Aspiration, incision and drainage, and/or antibiotics
- Parenteral amoxicillin, amoxicillin-sulbactam, and clindamycin
- In less severe cases, oral antibiotics can be used for 7 to 10 days (i.e., amoxicillin, amoxicillin-clavulanate, clindamycin)
- Tonsillectomy may also be considered in about 10% of patients
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| Pharyngitis |
Usually viral - adenovirus most common
- Mononucleosis: Epstein Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes, + heterophile agglutination test (monospot)
- Consider gonorrhea pharyngitis in patients with recent sexual encounters, or with non-resolving pharyngitis
- Fungal in patients using inhaled steroids
- Group A Streptococcal pharyngitis: S. pyogenes. Centor Criteria: Absence of a cough, exudates, fever, cervical lymphadenopathy. Throat culture is the gold standard
TX:
- Viral: supportive
- Mononucleosis: Symptomatic and avoid contact sports, antibiotics such as amoxicillin or ampicillin may cause a rash
- Fungal: clotrimazole, miconazole, or nystatin
- Group A Strep: Penicillin is first line, Azithromycin if Pen allergic. Complications: Rheumatic fever and post-strep glomerulonephritis
- Gonorrhea pharyngitis: follows the same principles for the approach to therapy of uncomplicated urogenital gonococcal infections, with a preferred regimen of intramuscular ceftriaxone (250 mg) and azithromycin as a second agent
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Sialadenitis
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Sialadenitis is a bacterial infection of a salivary gland usually caused by sialolithiasis which is an obstructing stone in the salivary gland
- Acute swelling of the cheek which worsens with meals
- etiology: S. aureus
- Diagnose with CT, ultrasonography, or MRI
TX: Dicloxacillin, 1st gen cephalosporin, or clindamycin, symptomatic: hydration, sialalogues |
| Parotitis |
Mumps is caused by paramyxovirus. Likely in a child without a complete vaccination series
- Typically, it begins with a few days of fever, headache, myalgia, fatigue, and anorexia, followed by parotitis; the illness is usually self-limited
- In adult males look for an associated orchitis
- Viral infections associated with parotitis include influenza A virus, parainfluenza, adenovirus, coxsackievirus, Epstein-Barr virus (EBV), cytomegalovirus, herpes simplex virus, human immunodeficiency virus (HIV), and lymphocytic choriomeningitis virus
TX: Self-limiting treat with hydration and rest
- Vaccination is effective for prevention
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| Leukoplakia |
Oral leukoplakia is an oral potentially malignant disorder that presents as white patches of the oral mucosa that cannot be wiped off with a gauze
- Tobacco use (smoked and especially smokeless), alcohol abuse, HPV infections
- Leukoplakia is in itself a benign and asymptomatic condition. However, some patients will eventually develop squamous cell carcinoma (SCC)
TX: Biopsy and surgical excision, destructive therapies (eg, laser ablation, cryosurgery), medical therapies (eg, retinoids, vitamin A, carotenoids, NSAIDs), and watchful waiting with close clinical and histologic follow-up
Oral hairy leukoplakia is a separate disorder that is not premalignant. It is an Epstein-Barr virus-induced lesion that occurs almost entirely in HIV-infected patients.
- Generally affects the lateral portions of the tongue, although the floor of the mouth, the palate, or the buccal mucosa may also be involved
TX: Unlikely to progress to squamous cell carcinoma
- Treatment with zidovudine, acyclovir, ganciclovir, foscarnet, and topical podophyllin or isotretinoin. Therapy is usually not indicated
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