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BDS - Module 9 > 12. Oral Medicine > Flashcards

12. Oral Medicine Flashcards

1
Q

Definition of a Sign:

A

A physical finding

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2
Q

Definition of a Symptom:

A

Evidence of a disease

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3
Q

What are the 8 signs of dry mouth?

A

Lack of saliva
Deep fissured tongue
Glossy palate
Dry mucosa
Evidence of candidiasis
Traumatic ulceration
Poor denture retention
Bacterial sialadenitis

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4
Q

What are the symptoms of dry mouth?

A

Difficulty functioning
Difficulty wearing dentures
Bad taste
Halitosis
Pain
Deteriorating dentition

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5
Q

List 7 possible causes of dry mouth:

A

Medications
Dehydration
Anxiety
Mouth breathing
Diabetes
Radiotherapy
Systemic disease

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6
Q

How would you assess dry mouth?

A

Challacombe scale

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7
Q

What investigation could you carry out to assess dry mouth?

A

Salivary flow rate

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8
Q

What are the 3 principles when managing dry mouth?

A

Prevention
Stimulation
Replacement

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9
Q

What is the challacombe scale?

A

A scale of 1-10 indicating serverity of oral dryness
1 = mild
10 = severe

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10
Q

What does challacombe score of 1-3 suggest and how would you manage this?

A

Mild Dryness
- monitor

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11
Q

What does a challacombe score of 4-6 suggest and how would you manage this?

A

Moderate Dryness
- investigate possible causes

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12
Q

What does a challacombe score of 7-10 indicate and how would you manage this?

A

Severe Dryness
- refer

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13
Q

How would you manage mild oral dryness?

A

Sugar free gym
Hydration

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14
Q

How would you manage moderate oral dryness?

A

Saliva stimulants (Sialogogues)
Saliva replacements
Topical fluoride

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15
Q

How would you manage severe oral dryness?

A

Saliva substitutes
Topical fluoride

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16
Q

List 5 conditions commonly associated with dry mouth:

A

Sjorgrens Syndrome
Bacterial Sialadenitis
Sialadenosis
Salivary Mucocoeles
Salivary gland tumours

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17
Q

What is sjorgresn syndrome?

A

A rare autoimmune chronic inflammatory condition that affects all exocrine glands in the body.

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18
Q

What are the 2 types of sjorgrens syndrome?

A

Primary - dry eyes and mouth only
Secondary - dry eyes, mouth and a connective tissue disorder

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19
Q

List 7 investigations used when sjorgrens is suspected:

A

Salivary flow rate
Lacrimal flow rate
Ocular staining score
Serology
Salivary gland biopsy
Ultrasound
Bloods

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20
Q

What is bacterial sialadenitis?

A

Inflammation of salivary glands caused by bacterial infections.

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21
Q

What are the signs of bacterial sialadenitis?

A

Salivary gland swelling
Pain
Redness of skin
Discharge from duct

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22
Q

What is salivary sialadenosis?

A

Salivary gland swelling

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23
Q

What are the signs of sialadenosis?

A

Bilateral swelling
Symmetrical

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24
Q

List 6 possible causes of sialadenosis:

A

Diabetes
Liver disease
Bulimia
Malnutrition
Pregnancy
Idiopathic

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25
Q

What are salivary mucocoeles?

A

A cystic cavity filled with mucous that present as blue/transparent swellings.

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26
Q

What is a ranula?

A

A cystic cavity filled with mucous found on the FOM.

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27
Q

List the 3 main stages of management of salivary gland tumours:

A
  1. Clinical exam
  2. Radiographic exam
  3. Tissue exam - fine needle aspiration, core biopsy, open biopsy, excisional biopsy
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28
Q

List 4 types of oral soft tissue lesion:

A

Commonly found lesions
White patches
Red patches
Ulcers

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29
Q

List 4 commonly used found soft tissue lesions:

A

Geographic tongue
Black hairy tongue
Amalgam tattoo
Vascular malformations

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30
Q

List 7 types of white patch commonly found in the oral cavity:

A

Genodermatoses
Leukoemdema
Frictional keratosis
Licked planus
Lichnoid reactions
Hairy leukoplakia
Psueodomembranous candida

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31
Q

List 5 types of red patch found in the oral cavity:

A

Geographic tongue
Erythematous candidosis
Angular chelitis
Denture stomatitis
Median rhomboid glossitis

32
Q

List the 2 different types of ulcers:

A

Recurrent aphthous stomatitis
Recurrent oral ulcerations

33
Q

Genodermatoses

A

An asymptomatic rough white patch that occurs due to genetic factors

34
Q

Leukoedema

A

An asymptomatic soft white patch that occurs due to low grade mucosal irritation causing oedema

35
Q

Frictional Keratosis

A

An asymptomatic rough white patch that occurs secondary to physical, chemical or thermal irritation.

36
Q

Licken Planus

A

A bilateral, symmetrical, painful, white patch that occurs due to medications, dental materials or due to unknown causes
- note: this is a potentially malignant disorder

37
Q

Hairy leukoplakia

A

A white patch found on the lateral border of the tongue caused by the Epstein Barr virus.

38
Q

Pseudomembranous Candidiasis

A

A removable white patch cause by infection of candida albucans.

39
Q

Geographic Tongue

A

An asymptomatic red patch with a cream border

40
Q

Erythematous Candidosis

A

Red patches

41
Q

List 3 red lesions associated with candidia infections:

A

Angular chelitis
Denture stomatitis
Median rhomboid glossitis

42
Q

Angular chelitis

A

Bleeding, cracking, redness at the angles of the mouth

43
Q

Denture stomatitis

A

Erythema (redness) of denture bearing area

44
Q

Median rhomboid glossitis

A

Depapilliation and redness of the tongue in a rhomboid shape

45
Q

List the 5 possible causes of oral ulceration:

A

Trauma
Medications
Idiopathic
Infective
Autoimmune

46
Q

List the signs of oral ulcers:

A

Superficial lesion
Yellow/cream colour
Red border

47
Q

List the 2 possible diagnosis’s of ulcers:

A
  1. Recurrent aphthous stomatitis - recurrent ulcers in the absence of any systemic disease
  2. Recurrent oral ulceration - recurrent ulcers associated with systemic disease
48
Q

List 7 GI conditions commonly associated with with recurrent oral ulceration:

A

GIT disease
Coeliac disease
Inflammatory bowel disease
Chrons
Ulcerative colitis
Carcinoma of the colon
Haemorrhoids

49
Q

How is recurrent oral ulceration managed?

A

Bloods
Haematinics
Immunology

50
Q

How is recurrent aphthous stomatitis managed in primary care?

A

Referral and Symptom Management:
- benzoate and cinnamon avoidance
- SLS free toothpaste
- topical analgesics
- topical steroids

51
Q

How is recurrent aphthous stomatitis managed in secondary care?

A

Topical steroids
Triple mouthwash
Systemic medications

52
Q

How is licken planus managed in primary care?

A
  1. Investigate any other site involvement
  2. Smoking cessation and alcohol advice as potential cancer risk
  3. Baseline Photos
  4. Symptom Management: diet modifications, SLS free toothpaste, topical analgesics, topical steroids
  5. Regular reviews
53
Q

How is licken planus managed in secondary care?

A

Topical steroids
Triple mouthwash
Systemic medications

54
Q

List the 6 groupings of orofacial pain according to ICOP:

A
  1. Dental related
  2. Myofascial
  3. TMJ related
  4. CN related
  5. Headache related
  6. Idiopathic
55
Q

List 2 CN related orofacial pain conditions:

A

Neuralgia
Neuropathy

56
Q

List 2 types of headaches:

A

Migraines
Tension headaches

57
Q

List 3 types of idiopathic orofacial pain conditions:

A

Burning mouth syndrome
Persistent idiopathic facial pain
Persistent idiopathic dental pain

58
Q

Trigeminal Neuralgia

A

A painful disorder of the Trigeminal nerve characterised by recurrent unilateral facial pain that lasts seconds to minutes.

59
Q

List the 3 types of neuralgia pain:

A

Classical - caused by neuromuscular compression
Secondary - caused by underlying disease
Idiopathic - unknown cause

60
Q

How is neauralgia diagnosed?

A
  1. History
  2. Examination: CN exam
  3. Investigations: MRI scan
  4. Diagnosis
61
Q

How is neauralgia managed:

A

Pharmacologically:
carbamazepine/oxycarbmazepine - first line
lamotrigine/baclofen/gabapentin/pregabalin - second line
Surgically:
destruction of grasserion ganglion
posterior cranial fossa surgery

62
Q

Glossopharyngeal Neuralgia:

A

A painful disorder of the glossopharyngeal nerve characterised by unilateral brief stabbing pain.

63
Q

Trigeminal Neuropathy

A

Constant facial pain in the distribution of the trigeminal nerve caused by another disorder.

64
Q

Features of neuropathy:

A

Allodynia - pain to a normal stimulus
Hyperalgesia - increased response to normal stimulus
Hypoalgesia - reduced response to normal stimulus
Hyperaesthesia - increased sensitivity to stimulus
Dysesthesia - abnormal sensation

65
Q

List 3 examples of Trigeminal neuropathies:

A
  1. Painful Trigeminal neuropathy attributed to the herpesvirus zoster virus
  2. Trigeminal post hermetic neuralgia
  3. Painful post traumatic Trigeminal neuropathy
66
Q

Idiopathic orofacial pain

A

Uni or bilateral intraoral or facial pain of unknown cause

67
Q

List the features of Persistent Idiopathic Facial Pain:

A

Poorly localised
Dull, ache pain
Neurological examination results normal

68
Q

How is persistent idiopathic facial and dentoalveolar pain investigated?

A

MRI
CT
CBCT

69
Q

How is persistent idiopathic facial pain managed in secondary care?

A
  1. Explain action of condition
  2. Self management techniques
  3. Topical Txs - lidocaine, capsaicin, levomenthol
  4. Systemic tx’s - amitriptyline, duloxetine
70
Q

Features of persistent idiopathic dentoalveolar pain:

A

Recurring daily dental pain of no known cause
Localised
Deep, dull, pressure pain
No obvious cause

71
Q

How is persistent idiopathic dentoalveolar pain maned in secondary care:

A
  1. Explanation of condition
  2. Self management techniques - relaxation, excercise, mindfulness, CBT
  3. Topical Tx - lidocaine
  4. Systemic Tx - amitriptyline, duloxetine
72
Q

Burning mouth syndrome:

A

An intraoral burning sensation of unknown cause

73
Q

List 4 possible local causes of burning mouth syndrome:

A

Parafunctijal habits
Dry mouth
GORD
candidosis

74
Q

List 5 possible systemic causes of burning mouth syndrome:

A

Anaemia
Haematinic deficiency
Diabetes
Thyroid dysfunction
Medications

75
Q

What investigations need to be done before burning mouth syndrome can be diagnosed?

A

Bloods, haematinics, HbA1c, TSH, ZN, Sialometry

76
Q

How is burning mouth syndrome managed?

A
  1. Explain condition
  2. Self management techniques
  3. Topical Tx’s - benzydamine, capsaicin, clonazepam
  4. Systemic Tx’s - amitriptyline, duloxetine

BDS - Module 9 (16 decks)

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