2007-2008 Flashcards
Oral manifestations of HIV?
Candida - White or red patch (erythematous)
• Acute Pseudomembranous Candida - Thrush. Non-adherent plaques which can be rubbed off.
• Acute atrophic candida - “antibiotic sore mouth” & steroid inhalers
• Chronic Hyperplastic Candidosis (assoc smoking- poss malignant)
• Chronic Atrophic candidosis (denture stomatitis and angular chelitis)
• Median Rhomboid glossitis (tongue red patches - rhomboid shape)
• Mucocutaneous candidosis
• Treatments:
o Treat underlying causes: Immunosuppression, long term steroid user, dentures, reduced OVD for angular cheilitis
o Treat pain: Difflam (benzydamine hydrochloride)
o Topical - Miconazole gel or nystatin suspension
o Systemic - Fluconazole/itraconazole
Hairy leukoplakia
- Bilateral White patch on the lateral border of the tongue. Plaque is usually soft and painless. Predominantly affects gay males. EBV. Generally does not require treatment. May regress with acyclovir but tends to recur.
HIV associated periodontitis (NUP, NUG, NUS)
- Spirochaetes, fusiform bacteria, anaerobic rods, similar to ANUG & NOMA
- In linear gingival erythema, candida may also play a role
- Removal of necrotic bone & severely affected teeth, debridement of necrotic tissue, 6% hydrogen peroxide irrigation (gets rid of oxygen), antibiotics – metronidazole, OHI & then periodontal management
Kaposi Sarcoma (HHV-8)
- Typically appears on palate
- Purplish/dark red area, which bleeds readily
- Can be first sign of HIV
Non-Hodgkins Lymphoma
- Radiotherapy, chemotherapy, intralesional chemotherapy, surgical excision
- Controlled rather than cured
Lesions in jaws associated with multinucleated giant cells?
- central giant cell granuloma which has fibrous tissue with osteoclasts benign but locally destructive , 10-30. In mandible , painless,radiolucency cyst in angle of mandible can be soap bubble appearance, tx by curate age
-peripheral giant cell granuloma : in gingivae , blue purple swelling, anterior, not on radiograph
-cherubism: autosomal dominant , bilateral swelling in posterior mandible, unerupted teeth , destroys permanent tooth buds, multilocular radiolucency lesions which displace teeth, multinucleated giant cells with fibrous tissue - hyperparathyroidism: brown tumour, 50 year women, increased PTH and calcium. Hemosiderin pigmentation, cyst swelling in jaw, mutilucalr lesions, osteoclasts in stroma, remove gland, decrease hormone
What factors determine how easy or difficult a lower third molar can be removed ?
-diagnosis
-type of impaction,
-depth in bone
-proximity to ID nerve
-if distoangular,mesioangular or transverse
-root form, number
Crown form and pathology
-any other pathology
-operator skill
-access
-pt compliance
-MH
What questions to ask pt if they have facial pain?
-where is pain
-cross midline
-when did it start acute or chronic
-describe pain
-alleviating factors
-exacerbations
-severity
-associations
-foul taste/ pus
-FM
-MH
What features distinguish between major, minor or herpetiform recurrent aphthous stomatitis?
-MINOR: 85%, 10-30 years, 3-8mm, 1-5 ulcers for 4-14 days, in font of mouth , heal without scarrring, on buccal mucosa
-MAJOR: 10%, 1.5-2cm so larger, single or multiple,3 weeks -3 months, posterior mouth, heal with scarring, on hard palate, dorsum tongue, gingivae,
-HERPETIFORM; <5%, children, 1-2mm, 10-30 ulcers, 7-10 days, FOM, ventral tongue, ulcers can join to form large ulcers,
What x rays might be relevant for someone who has lost teeth in a fight and deformity of cheeks?
Might suggest a fractured Zygoma or some sort of fracture . Orbital fracture
-PA: assess retained roots, roots morphology
-occipitomental: shows orbital margins, malar buttress and antrum 10 and 30 degrees
-CT: more accurate and shows any orbital blow outs
-submentovertex:shows zygomatic arch
-chest x ray: if teeth have been aspirated if they unconscious
CT more 3d
Histological features of SCC?
Infiltration of carcinoma into underlying CT, fat and bone , muscle
-invading into surrounding tissues by malignant epithelial cells
-islands of tumours
-inflammatory reaction
-dysplasia
-irregular epithelial stratification, loss of Basal cells, drop rete pegs
-mitotic figuures, cellular and nuclear pleomorphic m, nuclear hyperchromatism, individual cell keratinisation,
-perineural spread, lymph node involvement,
How to know prognosis and how it affects outcome of oral SCC?
-grading indicates prognosis and can differentiate more aggressive from less arrive carcinomas, do biopsies to grade
-well differnatated carcinomas resemble cell of origin and express keratin like keratin pearls,poorly differentiated dont resemble cell of origin and dont produce keratin, infiltrate more widely , metasitise , poorer prognosis
-depth of invasion and pattern of invasion so if cohesive or non cohesive
What can be used to aid diagnosis of an oral infection and how to collect and transport?
-If pus then swab, clean mucosa, incise, send sample in transport medium of water, salt, reducing agent and activated charcoal.
-Aspirates, leave in syringe, make needle safe
-Paper points send in transport medium
-for viral lesions use a viral transport medium of protein stabiliser and antibacterial agent or aspirate in vesicle fluid into tuberculin syringe
-fungal infections take an oral rinse 10ml of sterile saline washed in mouth for 30sec and spit into tube -have request form , state type of sample, where its from, clinical signs and symptoms and provisional diagnosis
-ask for culture and sensitivity
- label as biological substance category B.
Clinical and Histological features of odontogenic keratocyst ?
Arises from Dental lamina, replace tooth in arch, asymptomatic, slow growing pain
Take opt, CBCT, mri, ct, excisional biopsy, .
X-ray: well defined, corticated uni or multilocular radiolucency at angle of mandible. An displace roots, no buccolingual expansion . Can resemble dentigerous cyst or ameloblastoma,
GORLIN GOLTZ SYNDROME
Histology: thin parakeratinised SSE, inflammatory cells absent, fibrous ct with daughter cells, may have keratin in lumen no rete ridges,
TX: enucleation
Reasons for recurrence of ODONTOGENIC KERATOCYST
- satellite cysts/ daughter in wall
-may be a neoplasm
Thin fragile lining so hard to extract
-grows into cancellous bone
Poor surgical technique
Mitotic potential in epithelium
Pseudo recurrence
Why might a odontogenic keratocyst be a neoplasm?
High proliferative activity of epithelial lining
Caused by mutation/. Deletion of tumour suppressing gene ( PTCH)
May contain defects of other tumour suppressor gene p16, p53
Associated with BCC in gorlin glotz
Aggressive growth pattern
Can get SCC
Recurrence
What drugs can cause lesions ?
- lichenoid reactions from gold, penicillamine( treat kidney stones) ,allopurinol(gout)
-ulcers from gold, Nicorandil, methotrexate, penicillamine. Ulcers break in epithelium covered by fibrin slough, inflammatory cells,
-pigmented lesions from amalgam, tetracyclines
If small round radiopacity at angle of mandible ?
Diffential: calcified lymph node, salivary calculi, ghost image
-ask if pain, swelling, pus, metallic taste, hard to swallow, previously, trauma,MH,weight loss, feeling unwell, recovered infections,
-x rays: lower standard occlusal, lower oblique occlusal , sialography
