43. Oral and nasal lesions Flashcards
ddx oral lesions
Benign
Simple aphthous ulcers
Malignant
Squamous cell carcinoma
Infection
Herpes simplex virus
Hand, foot and mouth disease (coxsackie A virus)
Erythema multiforme
Secondary syphillis
Candida
Systemic disease
Inflammatory bowel disease (e.g., Crohn’s disease)
Coeliac disease
Connective tissue diseases (e.g., rheumatoid arthritis and systemic lupus erythematosus)
Vitamin deficiency (e.g., iron, B12, folate and vitamin D)
HIV
what are apthous ulcers
Aphthous mouth ulcers are painful, clearly defined, round or ovoid, shallow ulcers that are confined to the mouth and are not associated with systemic disease. They are often recurrent, with onset usually in childhood.
precipitating factors apthous ulcers
People with recurrent ulcers may have a genetic predisposition. Precipitating factors include:
Oral trauma (for example excessive tooth brushing).
Anxiety or stress.
Certain foods (typically chocolate, coffee, peanuts, almonds, strawberries, cheese, tomatoes, and wheat flour).
Stopping smoking.
Hormonal changes related to the menstrual cycle.
Most aphthous ulcers heal within 10-14 days without scarring.
plan ?apthous ulcers
- avoidance of ppting factors
+ symptomatic e.g. a short course of a low potency topical corticosteroid (hydrocortisone lozenges), an antimicrobial mouthwash, or a topical analgesic.
REFER 2ww mouth ulcer that persists for more than 3 weeks
management oral candida
systemic or widespread eg difficulty or pain on swallowing, or retrosternal pain
1. admit
mild and localised = topical 14 days
1. miconazole oral gel first-line
2. nystatin suspension
extensive or severe infection
1. oral fluconazole 50mg a day for at least 14 days
+ consider testing for risk factors for oral candidiasis, such as diabetes and haematinic deficiencies
what is gingivitis?
periodontal disease. It causes irritation, redness, swelling and bleeding of your gingiva, which is the part of your gum around the base of your teeth.
most common cause gingivitis
poor dental hygiene
how to tell wgen gingivitis is severe
simple gingivitis (painless, red swelling of the gum margin which bleeds on contact)
acute necrotizing ulcerative gingivitis (painful bleeding gums with halitosis and punched-out ulcers on the gums).
management simple gingivitis
seek routine regular review by a dentist. Antibiotics are not usually necessary
management acute necrotizing ulcerative gingivitis
refer the patient to a dentist, meanwhile the following is recommended:
oral metronidazole* for 3 days
chlorhexidine (0.12% or 0.2%) or hydrogen peroxide 6% mouth wash
simple analgesia
what is bechets disease? features?
complex inflammatory condition affecting the blood vessels and tissues. The main features are recurrent oral and genital ulcers. It can affect other areas, such as the eyes, skin, gastrointestinal tract, lungs, blood vessels, musculoskeletal system and central nervous system. Symptoms can range from mild to severe.
features of the lesions bechets
sharply circumscribed erosions with a red halo occurring on the oral mucosa and heal over 2-4 weeks
test to help ?bechets
The pathergy test involves using a sterile needle to make multiple pricks on the forearm. The area is reviewed 24-48 hours later to look for erythema (redness) and induration (thickening), indicating non-specific skin hypersensitivity. A positive result can indicate Behçet’s disease, Sweet’s syndrome or pyoderma gangrenosum.
associations nasal polyps
asthma (particularly late-onset asthma)
aspirin sensitivity
infective sinusitis
cystic fibrosis
Kartagener’s syndrome
Churg-Strauss syndrome
what is samters triad
asthma, aspirin sensitivity and nasal polyposis
