- these produce about 0.5 L of secretions/day

- product acts as a lubricant, maintains dental hygiene, and aids in digestion of starch

Salivary glands

- largest salivary gland

- empties adjacent to the upper 2nd molar via Stenson's ducts

Parotid gland

- submandibular glands lie beneath mandible and drain via these that lie on either side of the lingual frenulum

Wharton's ducts

- palpation of the tongue/oral cavity with a gloved hand primarily is used to detect these earlier than with inspection alone

Oral cancers

- most common oral malignancy

- usually squamous cell that occurs on lower lip

- use of tobacco, alcohol, and sun exposure increase risk

- presents w/ 1 cm or less superficial nodule or ulcer

Carcinoma of the lip

- these do not regularly occur on the lips, but when they do, are primarily found on upper lip

Basal cell carcinoma

- if a lesion on the lip is present for more than 3 weeks without healing, this should be done

Biopsy

Angular stomatitis

- reddening and cracking at one or both angles of mouth

Poor fitting dentures, Vit B or iron deficiency

Carcinoma of the lip

- most common oral malignancy

- usually squamous cell (lower lip)

tobacco, alcohol, sun exposure increase risk

Carcinoma of the tongue

- most common intraoral carcinoma

- usually ventral-lateral surface of tongue

- 1/2 pts with adv. carcinoma die in a year

- most common intraoral site for carcinoma

- cancer usually found on ventral-lateral surface

- pts will first notice a sore area on the surface before observable growths are present (hard areas or ulcers)

Tongue

- reddening and cracking at 1 or both angles of the mouth

- superficial ulceration and crusting is common

- common in pts with poor fitting dentures, Vit B deficiencies and iron deficiency

Angular stomatitis (cheilosis)

- non-specific term for "white lesion"

- can result from chronic minor trauma (thickening of mucosa), carcinoma (can't be scraped off), candida infections, and Epstein-Barr

Leukoplakia

- squamous cell carcinoma may initially present as this

- cannot be scraped off of the mucosa with tongue depressor

White patch

- white plaques surrounded by red margins may be caused by this

- can be easily scraped off the tongue with a depressor or cotton swab

Candida infection

- occurs on lateral surfaces of the tongue

- keratin projections give a hairy appearance due to keratinocyte infection by Epstein-Barr

- associated almost primarily with HIV

Hairy leukoplakia

Leukoplakia

- white spots on oral mucosa result from thickening of mucosa

Chronic minor trauma, squamous cell carcinoma, candida infections

Hairy Leukoplakia

- lateral surfaces of the tongue, keratin projections

Epstein-Barr virus (HIV)

Adrenal insufficiency hyperpigmentation

- diffuse hyperpigmentation of skin and mucous membranes secondary to increased production of ACTH

Adrenal insufficiency (Addison's)

Peutz-Jeghers

- inherited disease characterized by intestinal hamartomatous polyps and increased spotty pigmentation of lips and buccal mucosa

- sharply delineated area of varying size of reddened mucosa

- common in floor of mouth and retromolar areas

- more than 1/2 represent invasive carcinomas

Erythroplakia

- these people develop diffuse hyperpigmentation of the anterior buccal mucosa and gingiva (melanosis)

Smokers

- causes diffuse hyperpigmentation of the skin and mucous membranes due to increased ACTH production --> increased MSH

Primary adrenal insufficiency

- inherited disease that presents with spotty buccal/lip hyperpigmentation and intestinal hamartomatous polyps

Peutz-Jeghers syndrome

- observed in systemic amyloidosis, Down's syndrome and hypothyroidism

- due to muscle hypertrophy, sarcomas of the tongue, or infiltration with proteinaceous material

Macroglossia (large tongue)

- benign overgrowth and discoloration of the filiform papillae on the anterior 2/3 of tongue

- generally asymptomatic (sometimes foul taste/odor)

- sometimes associated with smoking or oral antibiotics

Hairy tongue

- benign, asymptomatic circumscribed patches of atrophic reddish mucosa bordered by thin raised margins of hypertrophic mucosa

- atrophy from loss of filiform papillae

Geographic tongue

Geographic tongue

- benign, asymptomatic circumscribed patches of atrophic reddish mucosa bordered by thin raised margins of hypertrophic mucosa

- tongue inflammation that manifests as papillary hypertrophy or atrophy

- change in taste or burning sensation may be present

- may appear pale, smooth, shiny or strawberry red and glanular

- caused by iron deficiency, Vit B deficiency, alcoholism, IBS, amyloidosis, and bacterial infections

Glossitis

Atrophic glossitis

- tongue inflammation that manifests as papillary hypertrophy or atrophy

iron or Vit B deficiency, alcoholism, IBS, amyloidosis, bacterial infections

- most common cause of hypertrophy of the gums

Periodontal disease (gingivitis)

- vit C deficiency (scurvy), phenytoin or cyclosporin A, monomyelocytic leukemia

Causes of gum hypertrophy

Gingivitis (advanced)

- bleeding and hypertrophy of gums

Periodontal disease

(other bleeding cause= platelet dysfunction)

- darkly pigmented line paralleling the insertion of the teeth at the gum line may indicate this condition

Lead poisoning

Tetracycline staining

- brown discoloration of the teeth common in smokers

- also caused by use of tetracycline during pregnancy or infancy

Smoking, Tetracycline, Dead teeth

Hutchinson's incisors

- deeply notched upper incisors

Congenital Syphilis

Mulberry Molar

- crown consists of an aggregation of enamel globules

Congenital Syphilis

Torus

- mucosal lined, cartilage-capped exostosis at midline of hard palate that protrudes downward from roof

Benign

- suggests the presence of an occult cleft palate

- primarily found in children with a history of recurrent otitis media

Bifid uvula

- peritonsillar abscess in a pt with sore throat can present with this uvula finding

Displacement to one side

- pulsation of the uvula can occur with chronic aortic insufficiency (wide pulse pressure)

Mueller's sign

- commonly develops during viral and bacterial upper respiratory tract infections

- only 5-15% are strep throat

Erythema of the pharynx

- pharyngeal exudate, cervical lymphadenopathy, headache, nausea with onset

Findings that make strep infection more likely

- crimson erythema of the anterior pharyngeal pillars has been described with this syndrome

- rarely associated with pain

- color fades over 3-6 months

Chronic fatigue syndrome

Exudative pharyngitis

- white patches (exudate) do no reliably distinguish between bacterial and viral infection

Streptococcus or virus

Aphthous ulcers (canker sores)

- shallow, painful, mucosal ulcers that have yellow-white centers and red rims

local mechanical trauma or burns

Herpes simplex type 1

- can cross over vermillion border to affect nearby skin

Herpes simplex virus

- remains confined to the lip and does not cross over to involve the skin

- ulcers on lip occur from this virus

- can occur with pharyngitis that is also associated with small blisters on the palms and soles (herpangina)

Coxsackie

- unlike juniper berries (gin), fusel oil (whiskey), grapes (wine), hops (beer), and acetaldehyde metabolites this substance is odorless

Ethanol

- characteristic smell of diabetic ketoacidosis

- fruity quality

Acetone

- breath that smells of ammonia is associated with this

- associated with di/trimethylamine and mercaptens or dimethylsulfide respectively

Kidney failure (fishy) or Liver failure (musty)

- sewage breath is caused by the presence of this kind of bacteria that may reside in the mouth, respiratory tract or upper GI.

- particularly common with periodontal disease, abscesses of the oral cavity, tonsillar infection, and intestinal obstruction

Anaerobic bacteria