Metabolism And Homeostasis I: Oral Health

Front 1

Surgery to bring both the lower and upper jaws forward to expand the upper airway may be indicated in which condition?

Back 1

Obstructive Sleep Apnea

Front 2

What is the most common type of oral cancer?

Back 2

Squamous cell carcinoma (>90%)

Front 3

What is the #1 modifiable single risk factor for oral cancer? What are three other modifiable risk factors?

Back 3

-Smoking (RR = 2-7) is most problematic
-Alcohol consumption (synergistic with smoking), Sun exposure, Nutritional deficiencies

Front 4

Are men or women more at risk for oral cancer?

Back 4

Men

Front 5

HPV is a risk factor for which type of oral cancer? Which two strains are associated with increased risk?

Back 5

Oropharyngeal carcinoma. Strains 16 & 18.

Front 6

What is the most common cause of increased (pathogenic) tooth mobility?

Back 6

Periodontal disease

Front 7

What is the most common location for oral SCC to occur?

Back 7

Lower Lip

Front 8

What are the five most common intra-oral locations for oral SCC?

Back 8

Tongue (25-40%), Floor of mouth, Palate, Gingiva, Buccal mucosa (so, basically anywhere)

Front 9

White plaque which cannot be rubbed off or characterized as any other disease is considered what?

Back 9

Leukoplakia

Front 10

What are four common presentations of oral SCC?

Back 10

Erythroplakia, Ulcer, Mass, Leukoplakia

Front 11

What is the timeframe for an oral lesion becoming worrisome?

Back 11

Any lesion which lasts more than 2 weeks is at risk for being cancer.

Front 12

Which percentage of leukoplakia represents dysplastic or malignant growth? What about erythroplakia?

Back 12

Leukoplakia: 5-25%
Erythroplakia: 50-90% (Red is bad!)

Front 13

What size mass is considered a T2 tumour for an oral SCC?

Back 13

> 2 cm and < 4 cm

Front 14

What is the difference between an N2b and an N2c tumour? (I'm not sure if we have to know this much detail)

Back 14

N2b: Multiple ipsilateral nodes (none > 6cm)
N2c: Bilateral or contralateral nodes (none > 6cm)

Front 15

What is the most common site of metastasis for oral SCC? What are two other common (ish) locations?

Back 15

Lung (66%); Bone (22%); Liver (9.5%)

Front 16

What is the primary treatment modality for treatment of cancer in the oral cavity? Does this change in oropharyngeal cancer?

Back 16

Surgery for oral cavity. Oropharyngeal isn't as clear-cut, and may involve radiation as first-line treatment

Front 17

Mucositis and Xerostomia are possible complications of what treatment method for oral SCC?

Back 17

Radiation. Destruction of the salivary glands can occur, causing dry mouth (Xerostomia). Inflammatory cytokines are also produced, causing mucositis.

Front 18

When is chemotherapy used in oral SCC?

Back 18

Chemo is typically used in palliative care, for advanced tumours. Often used in combination with radiation for treatment.

Front 19

For all types of oral SCC combined, what is the approximate 5-year survival? (30%, 60%, 75%, 85%)

Back 19

60%. (~59%)

Front 20

What is the single most powerful predictor of survival in oral SCC?

Back 20

Presence of nodal metastasis (deceases 5-year survival by 50%)

Front 21

What is particular about the causative agent in odontogenic infections? How does this affect treatment?

Back 21

Almost all involve multiple bacterial species, including aerobic and anerobic. Multiple antibiotics with different spectrums must be used to hit all the different bacteria.

Front 22

Is staphylococcus a common cause of odontogenic infections?

Back 22

No.

Front 23

An unwell-appearing 37-year old man presents with difficult breathing and swallowing, has a fever, and a trismus to greater than 10mm. What is this possibly indicative of (remembering, of course, that this is the oral health block)?

Back 23

Possible severe odontogenic infection. Fever and breathing obstruction are markers of high severity.

Front 24

What is the term for the inability to open one's mouth to its normal height?

Back 24

Trismus

Front 25

What is the most important part of treating odontogenic infections?

Back 25

Source identification (e.g. dental caries, percussion-sensitive teeth, vestibular swelling)

Front 26

What is the first-line antibiotic treatment for odontogenic infections?

Back 26

Penicillin (aerobes and gram +ve cocci) or Amoxicillin plus Metronidazole (for anerobes)

Front 27

Systemic antibiotic therapy is a predisposing factor for what common oral condition?

Back 27

Candidiasis (Thrush)

Front 28

What are the 5 clinical presentations of oral candidiasis? (PEMAC)

Back 28

Pseudomembranous (thrush); Erythematous (under upper dentures, red); Median rhomboid glossitis (midline of the dorsal tongue); Angular cheilitis (corners of the mouth); Chronic hyperplastic (does not rub off, looks like leukoplakia)

Front 29

What are two common treatments of oral candidiasis?

Back 29

Nystatin oral rinse (4x/day/14days, hold in mouth for 10 minutes); Fluconazole (once daily, 2-3 weeks)

Front 30

What is the most common cause of periodontal disease?

Back 30

Bacterial plaque

Front 31

What are the two stages of periodontal disease? Are they reversible?

Back 31

Gingivitis (reversible inflammation of superficial soft tissues); Periodontitis (irreversible inflammation of deeper supporting structures)

Front 32

What is the most important treatment and prevention of periodontal disease?

Back 32

Proper oral hygiene (flossing and brushing); Routine dental care

Front 33

By what age should a child see a dentist?

Back 33

Age 1.

Front 34

What are some strategies for management of teething in infants?

Back 34

- Cooled cloth or teething ring
- Acetaminophen/Ibuprofen analgesics
- Don't use topical analgesics

Front 35

What are the quadrant divisions of teeth numbering in infants?

Back 35

5: Maxillary right; 6: Maxillary left; 7: Mandibular left; 8: Mandibular right

Front 36

How can you effectively examine the head and neck area of an infant?

Back 36

Knee to Knee examination

Front 37

Yellowish de-colouring that can be wiped away associated with white chalky areas near the gingival margins in a child may be indicative of what?

Back 37

Early childhood caries. Demineralization of the teeth is occurring.

Front 38

What is the best drink for children between meals?

Back 38

Fluoridated water

Front 39

What approximate window of time designates the eruption period for baby teeth? At which time should a dentist be consulted if no eruption occurs?

Back 39

- 6 months (first teeth) - 30 months (for all teeth)
- If no eruption occurs after 18 months, consult a dentist

Front 40

What is the typical order of eruption of baby teeth, regardless of maxillar or mandibular origin? (Incisors, Cuspid, First molar, Second molar)

Back 40

Inscisor (~6-9 mo); First molar (12-14 mo); Cuspid (16-18 mo); Second molar (20-24 mo)

Front 41

How many baby teeth does a normal child have?

Back 41

20

Front 42

What are four high risk biological factors for early childhood caries?

Back 42

Mother with active cavities; Low SES; More than 3 between-meal sugar-containing snacks or drinks per day; Put to bed with a bottle

Front 43

Opaque white specks on the tooth may be indicative of what condition?

Back 43

Fluorosis

Front 44

How much toothpaste should be applied on a toothbrush for a child less than 3 years of age? What about from 3-6?

Back 44

< 3: Rice grain
3-6: Pea size

Front 45

What is pyorrhea also known as?

Back 45

Periodontitis