2: Oral manifestations of systemic disease

Question 1

What papillae are found in a V shape towards the posterior end of the tongue?

Answer 1

Circumvallate papillae

Question 2

Foliate papillae are associated with which lymphatic tissue?

Answer 2

Tonsils

Question 3

What is an exostosis?

Answer 3

Cartilaginous growth off a bone as part of normal development

Question 4

What normal bony growths are found underneath the tongue?

Answer 4

Torus mandibularis

Question 5

If you have any doubt over whether or not an oral finding is normal, what should be done with the patient?

Answer 5

Referred

Question 6

What is angular cheilitis also known as?

Answer 6

Angular stomatitis

Question 7

What is the underlying cause of angular cheilitis?

Answer 7

Anaemia

Haematinic deficiency (iron, Vitamin B12 and folate)

Question 8

What does angular cheilitis look like?

Answer 8

Inflammation of corners of lips

Question 9

What do mouth ulcers look like?

Answer 9

Superficial

Round

Yellow

Question 10

Apthous ulcers are (a one off / recurrent).

Answer 10

recurrent

Question 11

What causes apthous stomatitis (mouth ulcers)?

Answer 11

Anaemia

Haematinic deficiency (Iron, Vitamin B12 or folic acid)

Question 12

What is haematinic deficiency?

Answer 12

A deficiency of:

Iron

Vitamin B12

Folate

Question 13

People with recurrent mouth ulcers should be screened for which GI diseases?

(Which testing method is used?)

Answer 13

Coeliac disease; IBD

IgA-tTG test; Colonoscopy

Question 14

Which disease, other than coeliac disease, can cause mouth ulcers due to damage to the oral mucosa and malabsorption?

Answer 14

Crohn’s disease

Question 15

Recurrent oral ulceration is, in general, an indication of ___ disease.

Answer 15

GI

Question 16

In Crohn’s disease, ulcers are similar to those seen in deficiency - where are they found?

Answer 16

Crevices in the mouth

Question 17

What aspect of the oral cavity can be inflamed in Crohn’s disease?

Answer 17

Gingiva

Question 18

What may be found in the inferior midline of the oral cavity in Crohn’s disease?

Answer 18

Mucosal tags

Question 19

What may be found in the palate of Type II diabetes patients?

Answer 19

Thrush

Oral candidiasis

Question 20

Upon scraping thrush from a patient’s palate, what would you see?

Answer 20

Erythema

Question 21

Who else may develop oral candidiasis?

Answer 21

Asthmatics who use ICS

Question 22

Oral thrush is a marker of ___ control of diabetes.

Answer 22

poor

Question 23

What endocrine disease is oral thrush an indicator of?

Answer 23

Type II diabetes

Question 24

Oral symptoms may occur as an adverse reaction to ___.

Answer 24

medication

Question 25

What is **nicorandil** used to treat? What class of drug is it?

Answer 25

**Angina** **K**⁺ **channel activator**

Question 26

What oral reaction do patients have to **nicorandil**?

Answer 26

**Mouth ulcers** insert pic

Question 27

If a patient develops ulcers **anywhere** after starting on **nicorandil**, what should you do?

Answer 27

**Stop using it**

Question 28

Where else may nicorandil-related ulcers appear?

Answer 28

**GI tract** (bad - bleeding, peritonitis) ## Footnote **Conjunctiva** **Anus**

Question 29

What disease causes lesions in the mouth, skin etc. and is potentially malignant?

Answer 29

**Lichen planus**

Question 30

What kind of oral lesions are caused by **lichen planus**?

Answer 30

White thready lesions ## Footnote **Wickham's striae**

Question 31

**Lichen planus** can also cause inflammation of the \_\_\_.

Answer 31

**gingiva**

Question 32

Can lichen planus lesions be removed by scraping?

Answer 32

**No**

Question 33

Oral manifestations of **lichen planus** tend to appear (unilaterally / bilaterally).

Answer 33

**bilaterally**

Question 34

What anti-hypertensive drug can cause lichen planus?

Answer 34

**ACE inhibitors**

Question 35

What dental procedure can cause lichen planus?

Answer 35

**Fillings**

Question 36

The causes of the vast majority of lichen planus are \_\_\_.

Answer 36

**unknown**

Question 37

How is **lichen planus** diagnosed?

Answer 37

**Biopsy**

Question 38

How is **lichen planus** treated?

Answer 38

**Usually isn't** - symptom management only ## Footnote **Topical steroids**

Question 39

What is a rare condition which has both **oral** and **conjunctival** manifestions?

Answer 39

**Mucous membrane pemphigoid**

Question 40

What is seen in the mouth of someone with **mucous membrane pemphigoid**?

Answer 40

**Blisters**

Question 41

Oral mucous membrane pemphigoid ___ without issue. Conjunctival mucous membrane pemphigoid can cause ___ and __ \_\_ \_\_.

Answer 41

**heals** **scarring , loss of sight**

Question 42

Who should someone with **mucous membrane pemphigoid** be referred to?

Answer 42

**Opthalmologist**

Question 43

What **rheumatic** disease has oral manifestations?

Answer 43

**Sjogren's syndrome**

Question 44

What is the oral manifestation of Sjogren's syndrome?

Answer 44

**Dry mouth**

Question 45

Who should a patient with dry mouth associated with Sjogren's syndrome be referred to?

Answer 45

**Rheumatologist**

Question 46

If your tongue spatula, or dental mirror, or gloved finger is **sticking** to the inside of the patient's mouth, what do they have?

Answer 46

**Dry mouth**

Question 47

Patients with a dry mouth tend to have ___ saliva.

Answer 47

**foamy**

Question 48

There are a lot of oral signs indicating ___ infection.

Answer 48

**HIV**

Question 49

Which oral infection, also seen in those with Type II diabetes, is seen in the oral cavities of HIV / AIDS sufferers?

Answer 49

**Thrush** / oral candidiasis

Question 50

What is **hairy leukoplakia**? What **acute** infection does it indicate? What **chronic** infection does it indicate?

Answer 50

Lesions on the lateral aspect of the tongue with a hairy appearance Epstein-Barr virus caused by HIV

Question 51

If **hairy leukoplakia** or **Kaposi's sarcoma** are found in a patient's mouth, what should they be tested for?

Answer 51

**HIV / AIDS**

Question 52

What type of **oral cancer** is seen on the tongue?

Answer 52

**Squamous cell carcinoma**

Question 53

Where in the mouth is squamous cell carcinoma found?

Answer 53

**Tongue**