Ms Report Nikol

DISORDERS OF THE ORAL
CAVITY
 Periodontaldisease, which encompasses both gingivitis
and periodontitis, is the most common cause of tooth loss
among adults.
 Cigarette smoking remains a key modifiable risk factor
for periodontitis.
Periodontal disease can be connected to a variety of
other systemic diseases: CVD, diabetes, and rheumatoid
disease.
DENTAL PLAQUE AND CARIES
Tooth decay - erosive process that begins with the

action of bacteria on fermentable carbohydrates in
the mouth, which produces acids that dissolve tooth
enamel.
Dental decay begins with a small hole, usually in a
fissure (a break in the tooth’s enamel) or in an area
that is hard to clean.
DISORDERS OF THE LIPS, MOUTH, AND
GUMS
ACTINIC CHEILITIS
CHANCRE
ALLERGIC CONTACT DERMATITS

HSV-1
APHTHOUS STOMATITIS CANDIDIASIS
EWING SARCOMA
ERYTHROPLAKIA KAPOSI SARCOMA

LEUKOPLAKIA
ORAL HAIRY LEUKOPLAKIA
LICHEN PLANUS
NICOTINE STOMATITIS
STOMATITIS
GINGIVITIS
HERPETIC GINGIVOSTOMATITIS
NECROTIZING GINGIVITIS
PERIODONTITIS
PREVENTION
 Mouth Care
 Diet
 Fluoridation
 Pit and Fissure Sealants
Dental Health and Disease
Periapical Abscess – abscessed tooth; involves a

collection of pus in the apical dental periosteum and the
tissue surrounding the apex of the tooth.
Acute periapical abscess - arises from an infection, usually
secondary to dental caries.
 Chronic periodontal abscess - occurs from a slowly
progressive infectious process; The infection eventually leads
to a “blind dental abscess,” which is actually a periapical
granuloma.
Clinical Manifestations
Abscess produces
a dull, gnawing, continuous pain, often with a surrounding cellulitis

and swelling of the adjacent facial structures, temperature sensitivity,
and mobility of the involved tooth; Fever and malaise
Medical Management
- needle aspiration or drill an opening into the pulp chamber to relieve
pressure and pain and to provide drainage. After the inflammatory
reaction has subsided, the tooth may be extracted or root canal therapy
performed. Antibiotics and analgesics may be prescribed.
Nursing Management
The patient is assessed for bleeding after treatment and is
instructed to use a warm saline or warm water mouth rinse to
keep the area clean. The patient is also instructed to take
antibiotic and analgesic agents as prescribed, to advance
from a liquid diet to a soft diet as tolerated, and to keep
follow-up appointments.
DISORDERS OF THE JAW
Temporomandibular Disorders
•Myofascial pain—a discomfort in the muscles
controlling jaw function and in neck and shoulder
muscles
•Internal derangement of the joint—a dislocated jaw, a
displaced disc, or an injured condyle
•Degenerative joint disease—rheumatoid arthritis or
osteoarthritis in the jaw joint
 Jaw pain ranging from a dull ache to throbbing
 Debilitating pain that can radiate to the ears, teeth, neck muscles, and facial sinuses.
 Restricted jaw motion and locking of the jaw
 sudden change in the way the upper and lower teeth fit together
 pt may hear clicking, popping, and grating sounds when the mouth is opened, and chewing
and swallowing may be difficult.
 headaches, earaches, dizziness, and hearing problems.
Assessment and Diagnostic Findings

- pain, dysphagia, difficulty chewing, difficulty with speech, or hearing difficulties.
- MRI
Medical Management
Combination of simple noninvasive therapies that may include:
1) Pt education on self-care
2) Cognitive behavior modifications
3) Physical therapy
4) Acupuncture
5) Psychosocial interventions
6) Analgesics
7) Oral appliance therapy
Jaw Disorders Requiring Surgical Management
 Simple fractures of the mandible without displacement, may require wiring or
surgery.
 Jaw reconstruction may be necessary in the aftermath of trauma from a severe
injury or cancer and can cause tissue or bone loss.
Mandibular fractures, maxillomandibular fixation (MMF; wiring the jaw shut)
is a viable option. Open reduction, internal fixation (ORIF) with plate fixation
is the surgery of choice.
Bone grafting may be performed to replace structural defects using bones
from the patient’s own ilium, ribs, or cranial sites.
Nursing Management
MMF generally requires a short period (7 to 10 days) of a liquid diet and oral
rinses followed by rehabilitation and a soft diet. After ORIF, patients are typically
on a liquid or soft diet for 4 to 6 weeks to allow for healing.
The most common complications are infection that may progress to osteomyelitis
(infection of the bone), alignment issues or hardware failure, and wound
dehiscence.
Dietary counseling is provided to ensure adequate protein intake with
supplementation as needed.
Oral care needs to be reinforced.
Patients are advised to take prescribed medications and to abstain from smoking.
Regular follow-up with the surgeon is required to ensure healing progressing.
DISORDERS OF THE
SALIVARY GLANDS
Parotitis
- most common inflammatory condition of the salivary glands.
- may be due to mumps (epidemic parotitis), a communicable disease caused by viral
infection and most commonly affecting unvaccinated children.
Medical Management
- maintaining adequate nutritional and fluid intake, good oral hygiene, applying cold
packs, discontinuing medications
- antibiotic therapy is necessary for bacterial parotitis and analgesics
- parotidectomy
Sialadenitis
- inflammation of the salivary glands
- may be caused by dehydration, radiation therapy, stress, malnutrition, salivary gland calculi
(stones; sialolithiasis), or improper oral hygiene.
- S. aureus
- symptoms: pain, swelling, and purulent discharge.
- massage, hydration, warm compresses, and sialagogues cure the problem
Chronic sialadenitis- due to decreased salivary flow and may be treated with
sialendscopy, an endoscopic procedure that allows for direct visualization of Stensen duct
(diagnostic) and instillation of antibiotics, corticosteroids, or irrigation (treatment),
particularly in adolescents with recurrent parotitis.
Salivary Calculus (Sialolithiasis)
- salivary calculi (stones), occur in 80% of cases in the submandibular gland.
- a calculus that obstructs the gland’s duct causes swelling and sudden, local,
and often colicky pain, which is abruptly relieved by a gush of saliva
- formed mainly from calcium phosphate
- Sialendoscopy is considered the standard treatment of sialothiasis.
- Lithotripsy, a procedure that uses shock waves to disintegrate the stone, may
be used instead of surgical extraction for parotid stones and smaller
submandibular stones.
Neoplasms
- may develop in the salivary gland
- Risk factors include prior exposure to ionizing radiation to the head and neck, older age, and
specific carcinogens introduced in specific work environments.
- . Most patients with a benign tumor present with painless swelling of the glands; patients with a
malignancy tend to have neurologic symptoms and persistent facial pain.
- Early-stage salivary gland tumors are curable with surgery alone. Dissection is performed to
preserve the seventh cranial nerve.
- Complications from surgery: Facial nerve syndrome and Frey syndrome.
Frey syndrome- aka auriculotemporal syndrome, involves facial sweating and flushing in the
general location of the (removed) parotid gland that occurs while eating. Can be treated with
botulinum toxin type A injections.
- Radiation therapy
- Chemotherapy
CANCER OF THE ORAL
CAVITY AND PHARYNX
Risk factors
• Tobacco and nicotine
• excessive use of alcohol
• infection with human papillomavirus (HPV)
• history of previous head and neck cancer
Pathophysiology
- Malignancies of the oral cavity are usually squamous cell carcinomas.
- Any are of the oropharynx can be a site but the lips, the lateral aspects of the tongue, and the
floor of the mouth are most commonly affected.
- associated with high risk HPV
• painless sore or lesion that bleeds easily and does not heal
• Present as red or white patch (leukoplakia) in the mouth or throat
• the pt may report tenderness, difficulty in chewing, swallowing, or speaking, coughing of blood-tinged
sputum, trismus (limited jaw range of motion), weight loss, a neck mass, or enlarged cervical lymph nodes
Assessment and Diagnostic Findings
• oral examination
• assessment of cervical lymph nodes
• Positron emission tomography-computed tomography
• MRI
• Endoscopy
• Laryngoscopy
• Biopsy
• testing of HPV status
Medical Management
•Surgical resection and chemoradiation (CRT) are associated with improved survival for all
adults over age 70, including those who are positive for HPV infection
• Cancer of the lip
• Radiation therapy
• Cancer of the tongue
• Radiation therapy
• Chemotherapy
• Radioactive interstitial
• external-beam radiation
• Total glossectomy
- cancer of the oral cavity has metastasized through the extensive lymphatic channel in the
neck region, requiring a neck dissection and reconstructive surgery of the oral cavity.
Nursing Management
• Assesses the patient’s nutritional status preoperatively, and a dietary
consultation may be necessary.
• pt may require enteral or parenteral feedings before or after surgery
• Assess the patient’s ability to communicate in writing before
surgery.
• Postoperatively, the nurse assess and maintain a patent airway.

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Ms Report Nikol

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DISORDERS OF THE ORAL

Tooth decay - erosive process that begins with the

ALLERGIC CONTACT DERMATITS

ERYTHROPLAKIA KAPOSI SARCOMA

Periapical Abscess – abscessed tooth; involves a

a dull, gnawing, continuous pain, often with a surrounding cellulitis

Assessment and Diagnostic Findings

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