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dental > 7 - Oral medicine > Flashcards

7 - Oral medicine Flashcards

1
Q

What are some of the causes of oro-facial soft issue infections?

A

VIRAL
- primary herpes
- herpangina
- hand foot and mouth

BACTERIAL
- staph
- strep

FUNGAL
- Candida

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2
Q

Describe primary herpetic gingivostomatitis.

A
  • acute infectious disease
  • caused by the Herpes Simplex virus 1
  • transmission by droplet formation with 7 day incubation
  • herpes labialis is a common secondary infection
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3
Q

What are the signs and symptoms of primary heretic gingivostomatits?

A
  • fluid filled vesicles, which rupture to painful rugged ulcers on the gingiva, tongue, lips, buccal and palatal mucosa (patients can be reluctant to eat or drink)
  • severe oedematous marginal gingivitis
  • fever
  • headache
  • malaise
  • cervical lymphadenopathy
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4
Q

How do you treat primary herpetic gingivostomatitis?

A
  • bed rest
  • soft diet/keep hydrated
  • paracetamol
  • antimicrobial gel/mouthwash
  • acyclovir (medically compromised children)
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5
Q

What is the most common complication of primary herpetic gingivostomatitis?

A

Dehydration

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6
Q

What causes the recurrence of herpes virus?

A
  • 50-75% recurrence as herpes labialis
  • triggered by stress, UV, being run down
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7
Q

What causes herpangina?

A

Coxsackie A virus

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8
Q

What causes hand foot and mouth?

A

Coxsackie A virus

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9
Q

How does herpangina present?

A
  • vesicles in the tonsilar/pharyngeal region which rupture to painful ulcers
  • lasts 7-10 days
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10
Q

How does hand foot and mouth present?

A
  • ulceration of gingiva, cheeks, tongue and palate
  • maculopapular rash on hands and feet
  • lasts 7-10 days
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11
Q

How do you manage herpangina?

A
  • bed rest
  • soft diet/keep hydrated
  • paracetamol
  • antimicrobial gel/mouthwash
  • acyclovir (medically compromised children)
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12
Q

How do you manage hand foot and mouth?

A
  • bed rest
  • soft diet/keep hydrated
  • paracetamol
  • antimicrobial gel/mouthwash
  • acyclovir (medically compromised children)
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13
Q

Define oral ulceration.

A

Localised defect in the surface oral mucosa where the covering epithelium is destroyed leaving an inflamed area of connective tissue

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14
Q

What history is required for an ulcer?

A
  • onset
  • frequency
  • number (present at on time)
  • site
  • size
  • duration
  • exacerbating dietary factors
  • lesions in other areas
  • associated medical problems
  • treatment so far (beneficial or not?)
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15
Q

What are common causes of oral ulceration?

A
  • unknown
  • infection
  • immune mediated disorder
  • vesiculobullous disorder
  • immunodeficiency disorder
  • neoplastic/haemotological
  • trauma
  • vitamin deficiency
  • recurrent apthous stomatitis
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16
Q

Give an example of an infection that causes ulceration.

A

VIRAL
- coxsackie
- herpes simplex
- HIV

BACTERIAL
- TB
- syphilis

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17
Q

Give an example of an immune mediated disorder that causes ulceration.

A
  • Crohns
  • SLE
  • coeliac
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18
Q

Give an example of a vesiculobullous disorder that causes ulceration.

A
  • bullous or mucous membrane pemphigoid
  • linear IgA disease
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19
Q

Give an example of a neoplastic or haemotogocial disorder that causes ulceration.

A
  • anaemia
  • leukaemia
  • cyclic neutropenia
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20
Q

Give an example of a deficiency that causes ulceration.

A
  • iron
  • B12
  • folate
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21
Q

Define RAU.

A
  • recurrent apthous ulceration
  • most common cause of ulceration in children
  • typically round or ovoid in shape with yellow/grey base
22
Q

What are the 3 patterns of RAU?

A
  • minor (<10mm, non keratinised mucosa, 10-14 days healing)
  • major (>10mm, non keratinised, multiple weeks to heal)
  • herpetiform (1-2mm, hundreds ay one time, no fever)
23
Q

Describe the aetiology of RAU.

A
  • unclear
  • hereditary predisposition in 45% of cases
  • iron deficiency 20%
  • GI eg coeliac
  • stress
  • menstruation
24
Q

What investigations are used in RAU?

A
  • diet diary
  • FBC
  • haematinics
  • coeliac screen
25
Q

How do you manage RAU?

A
  • diet analysis for exacerbating foods (deficiencies, traumatic eg avoid sharp/spicy, allergies)
  • low ferritin = 3 months iron supplements
  • low folate/B12 or positive anti-transglutaminase (coeliac) = refer to paediatrician
  • pharmacological
26
Q

How is RAU treated pharmacologically?

A
  • prevention of superinfection (corsodyl 0.2%)
  • protecting healing ulcers (gengigel or gelclair mouthwash, both hyaluronate)
  • symptomatic relief (difflam 0.15% benzydamine hydrochloride, LA spray)
27
Q

Describe OFG.

A
  • orofacial granulomatosis
  • uncommon chronic inflammatory disorder
  • idiopathic or associated with systemic Crohn’s disease or sarcoidosis
  • average age 11 years old
  • more common in males
28
Q

What are the clinical features of OFG?

A
  • lip swelling
  • full thickness gingival swelling
  • swelling of non-labial facial tissues
  • peri-oral erythema
  • cobblestone appearance of buccal mucosa
  • linear oral ulceration
  • mucosal tags
  • lip/tongue fissuring
  • angular cheilitis
29
Q

Describe the aetiology of OFG.

A
  • largely unknown
  • allergens including cinnamon compounds, benzoates
  • higher IgE mediated atopy rates than general population
30
Q

What investigations can be completed to diagnose OFG?

A
  • clinical
  • lip biopsy (not essential)
  • observe growth (Crohn’s)
  • FBC and haematinics
  • patch tests
  • diet diary
  • faecal calportectin (Crohn’s)
  • endoscopy
  • serum angiotensin converting enzyme (sarcoidosis)
31
Q

How do you manage OFG?

A
  • OH support
  • symptomatic relief
  • dietary exclusion
  • manage nutritional deficiency
  • topical steroids
  • short courses of oral steroids
  • intralesion corticosteroids
  • surgical intervention (unresponsive to other tx)
32
Q

What is geographic tongue?

A
  • idiopathic and non-contagious, benign
  • seen at young age
  • shiny red areas on tongue with loss of filiform papillae surrounded by white margins
  • causes intense discomfort (spicy food or tomato/citrus)
33
Q

How do you manage geographic tongue?

A
  • reassure parents that this is benign
  • bland diet during flare ups
  • haematinics for deficiencies
34
Q

What are causes of solid swellings in the mouth?

A
  • fibre-epithelial polyps
  • epulides
  • congenital epulis
  • HPV-associated mucosal swellings
  • neurofibromas
35
Q

Describe a fibre-epithelial polyp.

A
  • common
  • firm pink lump (pedunctulated or sessile)
  • usually in cheeks, also found in lips or tongue
  • does not change size
  • caused by minor trauma
  • excision is curative
36
Q

What are epulides?

A
  • common solid swelling of mucosa
  • benign hyperplastic lesion
  • 3 main types (fibrous epulis, pyogenic granuloma, peripheral giant cell granuloma)
37
Q

Describe fibrous epulis.

A
  • pedunculated or sessile mass
  • firm consistency
  • similar colour to surrounding gingiva
  • made up of inflammatory cell infiltrate and fibrous tissue
38
Q

Describe pyogenic granulomas.

A
  • also known as pregnancy epulis (regress after birth)
  • often ulcerated
  • haemorrhage spontaneously with mild trauma
  • vascular proliferation support by fibrous stroma
  • recur after removal
39
Q

Describe peripheral giant cell granulomas.

A
  • pedunculated or sessile swelling
  • typically dark red and ulcerated
  • arise inter proximally with an hourglass shape
  • radiograph can reveal superficial erosion of superficial bone
  • multinucleate giant cells in a vascular stroma
  • may recur after excision
40
Q

What congenital epulis?

A
  • rare lesion
  • occurs in neonates, F > M
  • most commonly anterior maxilla
  • granular cells covered with epithelium
  • benign
  • excision is curative
41
Q

What are the types of HIV associated swellings?

A
  • verruca vulgaris
  • squamous cell papilloma
42
Q

Describe verruca vulgaris.

A
  • single or multiple lesion
  • associated with skin warts
  • caused by HPV 2 and 4
  • found on keratinised epithelium (gingiva and palate)
  • resolve spontaneously but can be excised)
43
Q

Describe squamous cell papilloma.

A
  • small pedunculated (cauliflower like) growths
  • benign
  • caused by HPV 6 and 11
  • vary in colour from pink to white
  • usually solitary
  • excised
44
Q

What are causes of fluid filled swellings in the oral cavity?

A
  • mucoceles
  • ranula
  • Bohn’s nodules
  • Epstein pearls
  • haemangiomas
  • vesiculobullous lesions
45
Q

What are mucoceles?

A
  • 2 types (mucous extravasation cyst and mucous retention cyst)
  • bluish, soft, transparent cystic swelling
  • affect minor or major salivary gland
  • most common in lower lip minor glands
  • can be excised
46
Q

What is a ranula?

A
  • mucocele in FOM
  • arise in minor glands or ducts
  • ultrasound or MRI required to exclude plunging ranula (through FOM)
  • occasionally are lymphangioma (tumour)
47
Q

What are Bohn’s nodules?

A
  • gingival cysts
  • remnant of dental lamina
  • filled with keratin
  • occurs on alveolar ridge
  • found in neonates
  • self resolve in a few months
48
Q

What are Epstein pearls?

A
  • small cystic lesions
  • found in midline of palate
  • trapped epithelium in midline
  • 80% of neonates
  • disappear in first few weeks
49
Q

What is TMJDS?

A
  • temperomandibular joint dysfunction syndrome
  • characterised by pain, masticatory muscle spasm, truisms
50
Q

What history is required for TMJDS?

A
  • presenting symptoms
  • when did it begin
  • is it worse at a specific time of day (morning = clenching at night)
  • exacerbating factors
  • habits
  • stress
51
Q

How do you examine for TMJDS?

A
  • palate MOM at rest and with teeth clenched
  • palate TMJ at rest and when open/close (listen for click or crepitus, assess any deviation of jaw and extent of opening)
  • asses any NCSTL
  • signs of clenching in mucosa (scalloped tongue, buccal mucosa ridges)
52
Q

How do you manage TMJDS?

A
  • explain condition
  • reduce exacerbating factors (eg. manage stress, avoid habits)
  • bite splint
  • soft diet
  • symptomatic relief (ibuprofen, hot/cold compress)

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