Pathophysiology:Oral cavity disorders and hearing loss -Dr. Lopes

What is the only one oral disease that attacks that portion of the tooth exposed to the oral environment, causing decalcification of the tooth enamel and destruction of the protein matrix?
Dental caries
What is the disease that is from multiple rampant lesions of deciduous teeth of infants and children who bottle-feed?
Nursing bottle caries
What is the main bacterium that causes dental carries?
Streptococcus mutans
What is the disease with slightly swollen, red gingiva where it bleeds easily?
Marginal gingivitis
What are not correct about marginal gingivitis?
1. The marginal gingiva bleeds easily
2. Higher risk in older or very young people
3. Chronic inflammation may lead to hyperplasia
4. It is caused by viral infection
5. Limiting sugar is the key to prevent this
2. Higher risk in pregnancy and during puberty
4. It is caused by bacterial plaque
What is a very painful malodorous infection of gingiva that can cause systemic symptoms such as fever or cervical lymphadenopathy, which is rare in children?
Necrotizing ulcerative gingivitis - AKA Trench mouth.

-Infection is causing necrosis of the interdental papillae and marginal gingiva.
What is incorrect about Necrotizing ulcerative gingivitis?
1. It is also knowns as Trench mouth
2. It causes malodorous infection causing necrosis of the interdental papillae and marginal gingiva
3. Opportunistic pathogens, such as Streptococcus mutants may cause this
4. It may spread to be systemic
5. It is rare in children.
3. Opportunistic pathogens such as Borrelia vincentii and/or Leptotrichia buccalis (inn combination of reduced resistance with impaired immune response) can cause this.
What is the disease where gums are not firmly attached to the tooth and may recede and teeth often become loose with chronic progression of gingival inflammation?
What are incorrect about periodontitis?
1. It is an acute gingival inflammation
2. It is when gingival inflammation spreads to periodontal ligaments.
3. The common feature is gum line receding
4. The surrounding bone does not get infected.
5. It usually results in swollen gum and loss of teeth
1. It is chronic progression of gingival inflammation
4. Alveolar bone and cementum get inflamed as well. (And periodontal ligaments)
What is incorrect about periodontitis?
1. It is highly linked to poor dental hygiene
2. It can be developed from prior marginal gingivitis, but not always
3. The main bacteria involved is Borrelia vincentii.
4. It is from chronic progression of gingival inflammation.
5. Immune suppression can be a factor, such as HIV or diabetes.
3. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis,
Prevotella intermedia
About 50% of patients who take ( ) will develop Drug-induced gingival hyperplasia.
Phenytoin (Dilantin)
Which ones of the following incorrect about Drug-induced gingival hyperplasia?
1. The most common drug involved is Phenytoin(Dilantin)
2. The gingival overgrowth is from enlarged keratinocytes and fibroblasts and dental hygiene is not involved in this case
3. Patients who are older than 50s are most susceptible.
4. Drugs such as Cyclosporin A or amlodipine can cause this.
5. Marginal gingivitis may trigger this.
2. Poor dental hygiene or underlying dental disease are the probable triggers.
3. Patients under age 30 are the most susceptible.
What is a common painful oral lesion that begins as a red macule that ulcerates forming a pyogenic membrane with a characteristic yellow-white center surrounded by an erythematous flare. Usually occurs on movable mucosa such as lips and cheeks.
Aphthous stomatitis (Canker sores)
Which ones incorrect about Aphthous stomatitis?
1. Its ranges in size varies from less than 1 mm to 2 cm.
2. It forms pyogenic membrane with yellow-white center surrounded by an erythematous flare.
3. There is a link to HSV with this disease
4. It may be caused by variety of diseases all manifested by painful mouth sores
5. It is not related to diets or hormonal changes
3. Aphthous stomatitis is rarely due to HSV (But maybe from against self or an extrinsic antigen such as bacteria or virus)
5. It might be related to diets such as gluten, tomato products, or hormonal changes(such as during menses)
Which ones of the following are tumors and precancerous lesions-related disease?
1. Oral candidiasis
2. Periodontitis
3. Leukoplakia
4. Aphthous stomatitis
5. Squamous cell carcinoma
6. Hairy leukoplakia
7. Sialadenitis
3. Leukoplakia
5. Squamous cell carcinoma
What is a recurrent vesicular eruption in the region of the lips that has usually painful and pruritic prodrome, and due to HSV 1?
Herpes labialis (cold sore)
which ones are incorrect about Herpes labialis?
1. It is recurrent
2. Usually due to HSV 1 and 2
3. Initial infection often includes fever, irritability and lymphadenopathy in addition to oral lesion
4. Recurrences are usually more severe than the original lesion.
5. It can be in vesicles or pustule form.
2. Only HSV 1
4. Recurs with shorter duration than original lesion.
What is the most common fungal infection in the oral cavity that causes an white slough over the affected mucosa?
Candidiasis (Thrush)
Which ones are incorrect about Candidiasis?
1. It is the most common fungal infection in oral cavity
2. It presents with variable pain
3. Rubbing off the slough may help the symptom
4. It affects healthy infants and elderly patients often.
5. Long term antibiotic may be a good therapy for this
3. Rubbing off the slough reveals denuded red mucosa that may bleed
5. Long term antibiotic therapy may change the composition of the patient's oral flora and can be a risk factor
Usually benign, presumed precancerous plaque of oral mucosa that is usually benign hyperkeratosis..?
Which ones are incorrect about Leukoplakia?
1. It causes severe systemic pain.
2. It is usually benign and no need to presume precancerous.
3. Human paillomavirus is the main cause
4. It occurs more commonly in older males
5. Chronic smoking and alcohol intake may cause hyperkeratosis in leukoplakia
1. It is usually asymptomatic
2. may be benign but must presume precancerous
3. HPV is associated with squamous cell carcinoma
Which ones are incorrect about Leukoplakia?
1. It is more common in young females
2. Biopsy will show most lesions to be benign hyperkeratosis.
3. It is the most common fungal infection
4. It is usually due to HSV 1.
5. It forms pyogenic membrane with yellow-white center.
6. It must be presumed to be precancerous
1. more common in older males
3. Most common fungal infection is candidiasis
4. HSV 1 causes Herpes labialis
5. Pyogenic membrane with yellow-white center is Aphthous stomatitis
What is oral cancer that may appear as leukoplakia or erythroplasia in early stage and 50% of this cancer is associated with HPV?
Squamous cell Carcinoma (Oral SCC)
Which ones are incorrect about Squamous cell carcinoma?
1. It is the most common type of oral cancer.
2. It is more common in older females
3. Smoking and alcohol use are one of the risk factors
4. Epstein-Barr Virus is present in most cells
5. Certain drugs such as phenytoin can induce this cancer
2. more common in males over 40
4. Epstein-Barr virus is the pathogen for Hairy Leukoplakia
--~50% of Oral SCC is associated with Human papillomavirus(HPV)
--> Vaccination may decrease future occurrence of this cancer
5. Phenytoin can cause Drug-induced gingival hyperplasia.
Which ones are incorrect about Squamous cell carcinoma?
1. It may develop fibrous overgrowth of the gingiva.
2. Aggregatibacter actinomycetemcomitans are one of the pathogens of this cancer.
3. It is rare under age 40.
4. HPV vaccination may decrease future occurrence of this cancer
5. This may block the ducts of salivary glands.
1. Overgrowth of the gingiva is called drug-induced gingival hyperplasia that is caused from phenytoin(Dilantin) and some other drugs
2. Aggregatibacter actinomycetemcomitans may cause periodontitis, where gum line recedes
5. Salivary glands blockage causes Acute Sialadenitis (where saliva thickens and precipitates forms, blocking the ducts that drain the glands, followed by inflammation)
What kind of virus is associated with Squamous cell carcinoma?
Human Papillomavirus(HPV)
What is the cause of Hairy Leukoplakia?
Epstein-Barr Virus(EBV)
What is correct about Hairy Leukoplakia?
1. It can happen to immunocompromised patients but not too common.
2. Its pathogenesis is considered to be Epstein-Barr Virus
3. It is considered to be precancerous.
4. It is almost always situated on the lateral border of the tongue.
5. Hyperkeratosis is usually a reaction to repeated micro trauma and irritants such as smoking or alcohol intake.
1. Hairy leukoplakia denotes immunocompromise.
3. Leukoplakia can be presumed to be precancerous.
5. Hyperkeratosis from smoking or alcohol intake -->Leukoplakia
( ) is salivary gland inflammation/infection, usually due to obstruction and usually affecting the ( ) gland.
Acute Sialadenitis
Two common pathogen of Acute Sialadenitis
Staphylococcus aureus
Streptococcus viridans
Which of the following can be related to pathogenesis of Acute sialadenitis?
1. Staphylococcus aureus
2. Chronic dehydration
3. Chronic alcohol intake
4. Sjogren's syndrome
5. Epstein-Barr Virus
6. Human papillomavirus
7. Antihistamines
8. Cholinergic drugs
1. Staph aureus, Strepto viridans most common
2. Chronic dehydration can reduce saliva flow
4. Sjogren's syndrome can reduce saliva and tears
7. Antihistamins also reduce saliva flow

3. Chronic alcohol intake can be related to Leukoplakia, where hyperkeratosis is happening from repeated irritants such as smoking or alcohol intake.
5. EBV is present in Hairy Leukoplakia
6. Human Papillomavirus associated with Squamous cell carcinoma
8. "Dry" drugs can be pathogenic for Acute sialadenitis, such as anticholinergic drugs.
Which ones are incorrect about Acute sialadenitis?
1. Usually Staph aureus or Strepto Viridans targets blocked salivary gland ducts
2. It causes an infection and always treated with antibiotics
3. Its presence denotes immunocompromise.
4. It can cause oral cancer.
5. It usually occurs in submandibular gland.
6. Saliva thickens and precipitates form, blocking the ducts that drain the glands, followed by inflammation.
3. --> Hairy Leukoplakia
4. --> Squamous cell carcinoma (Oral SCC)
Which ones are conductive disorders?
1. Usher syndrome
2. Impacted cerumen
3. Meniere's disease
4. Cholesteatoma
5. Otosclerosis
6. Glomus
7. Chronic otitis media
8. Eustachian tube dysfunction
2. 4. 5. 8.

1. Usher syndrome: Genetic causes of hearing loss
3. Meniere's disease: Sensorineural disorders
6. Glomus: Tumors
7. Chronic otitis media : Sensorineural disorders
Which ones are conductive disorders?
1. Impacted cerumen
2. Waardenburg syndrome
3. Eustachian tube dysfunction
4. Cholesteatoma
5. Presbycusis
6.Acoustic neuroma
7. Otosclerosis
1, 3, 4, 7

2. Waardenburg syndrome: Genetic causes of hearing loss
5. Presbycusis: Sensorineural disorders
6. Acoustic neuroma: Tumors
Which ones are sensorineural disorders?
1. Presbycusis and noise-induced hearing loss
2. Glomus
3. Eustachian tube dysfunction
4. Meniere's disease
5. Recurrent otitis media
6. Alport syndrome
7. Neurofibromatosis type 2
1, 4, 5
( ) is condition that affects both hearing and vision, where eye disorder called retinitis pigmentosa is one of the forms.
Usher syndrome
Which ones incorrect about Usher syndrome?
1. It is inherited condition as an autosomal recessive trait.
2. It causes both hearing and vision loss
3. It changes in coloring of the hair and skin.
4. It can cause progressive kidney function.
5. It affects the outer and middle ear.
3. Change in color of hair and skin and eyes --> Waardenburg syndrome
4. Progressive kidney function --> Alport syndrome
5. Lesions in outer/middle ear --> Conductive hearing loss

(Usher syndrome hearing loss is due to malformation of the inner ear and hair cells)
Which ones incorrect about Usher syndrome?
1. It is nonsyndromic.
2. It is an inherited condition as an autosomal dominant trait.
3. It changes hair/eye/skin color
4. Hearing loss is due to malformation of the inner ear and hair cells
5. It is incurable.
1. Is syndromic --> Affects both eyes and ears
2. Autosomal recessive trait
3. Change hair/eye/ skin color --> Waardenburg syndrome
( ) is a group of genetic conditions that can cause hearing loss due to malformation of the inner ear and hair cells and changes in coloring of the hair, skin and eyes.
Waardenburg syndrome.
Which ones correct about Waardenburg syndrome?
1. It is inherited autosomal dominant trait
2. It causes loss if vision for both eyes
3. People with this have very pale blue eyes
4. The hearing loss is due to malfunction of tympanic membrane.
5. People with this have some alteration in type IV collagen.
1, 3

2. It does not cause vision loss. Just hearing loss
4. The hearing loss is due to malformation of the inner ear and hair cells.
5. Alteration in type IV collagen is seen in Alport syndrome.
Which one is correct about Alport syndrome?
1. It is a conductive hearing loss
2. It is characterized by progressive loss of kidney function and loss of hearing
3. Hematuria and proteinuria are common symptom
4. It causes retinitis pigmentosa.
5. There is an alteration in type IV collagen
2, 3, 5

1 --> it is a genetic condition
4 --> This is about Usher syndrome
Which one is correct about Neurofibromatosis type 2?
1. It is an autosomal recessive disorder.
2. There is growth of benign nervous tissue tumors.
3. Its early symptoms include hearing loss, tinnitus and problems with balance.
4. Tumors develop unilaterally
5. It can cause progressive kidney malfunction.
2, 3

1 -->Autosomal dominant disorder
(recessive is Usher syndrome)
4. Tumors usually develop bilaterally
5. Progressive kidney malfunction--> Alport syndrome
What is the most common tumors associated with NF2?
Acoustic neuromas
(Vestibular schwannomas)
-->Tumors of Cranial nerve VIII
Lesions in Auricle, external auditory canal or middle ear cause ( ) hearing loss and lesions in inner ear or eighth cranial nerve cause ( ) hearing loss.
What is this describing?
-The middle chamber can experience negative pressure, which pulls the tympanic membrane inward or can fill with fluid, pushing the TM outward and also attenuating movement of ossicles --> hearing loss and pain.
Eustachian tube dysfunction
(Conductive disorder)
The fluid that accumulates in the middle ear with eustachian tube dysfunction is ( ) that is not infected. If bacteria contaminate this fluid, a middle ear infection may result, called ( ).
Serous otitis media
Acute otitis media
Presence of abnormal proliferation of stratified squamous epithelium in the middle ear or mastoid in adults
What is incorrect about otosclerosis?
1. Autosomal dominant transmission
2. abnormal bone deposition in the middle chambers
3. Chronic otitis media triggers it
4. Fibrous ankylosis of the stapes
5. loss of normal ossicle movement results in loss of hearing
Noise-induced hearing loss occurs when prolonged exposure to noise that is greater than ( ) dB
( ) occurs when high-intensity impulse noise (ex >140 dB) penetrates cochlea before the ( ) reflex has been activated
acoustic trauma
Three top bacteria for chronic recurrent otitis media
Streptococcus pneumoniae, H. influenzae, Moraxella catarrhalis
T/F Chronic otitis media is conductive disorder
False. It is sensorineural disorder
What is this?
-Characterized by Episodic vertigo, fluctuating sensorineural hearing loss, tinnitus and aural fullness.
-Chronic symptoms
-Tinnitus and deafness may fluctuate
Meniere's disease
Miner's disease is caused by engorged ( )--fluid--leading to degeneration of vestibular and cochlear hair cells
membranous labyrinth
Ototoxic drug that causes irreversible destruction of cochlear hair cells
Ototoxic drug that cause tinnitis in mostly elderly people. mostly due to metabolic changes rather than structural changes in the cochlea
Acetylsalicylic acid(ASA)-Aspirin
Ototoxic drug that causes hearing loss, tinnitus and or vertigo 6-7% esp, with kidney disease. Cause edema of cochlear vascular tissue
Loop diuretics (Furosemide)
Ototoxic drug where rate of hearing loss in children is 61%
Platinum-based antineoplastics (Cisplatin)
What is incorrect about Gloms tumor?
1. It is benign vascular tumor
2. It occurs most often in young children
3. This is most rare benign neoplasm of the ear, which is not familial
4. It arises from smooth muscle cells within an arteriovenous anastomosis
5. Major symptoms include vertigo and vision loss
6. It is mixed conductive and sensorineural hearing loss
2. often in women ages 40-60
3. most common benign neoplasm of the ear, which is thought to be familial
5. Major symptoms include pulsatile tinnitus and hearing loss
A rare benign tumor arising from the vestibulocochlear nerve(Cranial nerve VIII)
Acoustic neuroma
( a ) is a rare benign tumor arising from cranial nerve VIII. It is the most common tumor found in the cerebellopontine angle and often occurs in women b/t 30-60. Always assume ( a ) in adults with ( b ) sensorineural heariing loss until proven otherwise
Acoustic neuroma