8 - OM problems in the elderly

Question 1

What is a haemangioma?

Answer 1

• malformation of venous vessels
• can rupture
• commonly found on FOM or inside of lip
• cryotherapy is curative

Question 2

What is a fibroepithelial polyp?

Answer 2

• benign
• cause by trauma
• commonly found on tongue, inside of cheek
• should be removed before ulceration begins

Question 3

What is black hairy tongue?

Answer 3

• variation of normal anatomy that has been stained by tannins
• common in smokers
• can smell
• difficult to get rid of
• ensure you clean forwards not backwards

Question 4

What is geographic tongue?

Answer 4

• white patches with smooth patches
• common in 10% of people
• can cause sensitivity
• area of atrophy

Question 5

What is atrophic glossitis?

Answer 5

• smooth tongue caused by low iron, folate or vit B12
• uncomfortable and can ulcerate
• should be referred to GP

Question 6

What is frictional keratosis?

Answer 6

• white patch commonly found on tongue
• caused by trauma
• similar to a callous
• if not cause could be malignant

Question 7

What is speckled leukoplakia?

Answer 7

• hyperplastic candidiasis
• speckled leukoplakia should ring alarm bells, as may be premalignant
• should be treated with antifungals, smoking cessation advice and biopsy

Question 8

What is sublingual keratosis?

Answer 8

• white patch under tongue
• if ventral and crossing the midline this is a high risk site for malignancy
• should be referred to OM

Question 9

What causes traumatic keratosis?

Answer 9

Ill fitting dentures

Question 10

What causes denture-induced hyperplasia?

Answer 10

• ill fitting dentures
• more common in lower

Question 11

How do you treat denture-induced hyperplasia?

Answer 11

• trim denture away to relieve soft tissue
• surgical removal

Question 12

How do you prevent denture stomatitis?

Answer 12

• denture hygiene vital
• anti fungals if required
• new denture made as fungus may have infiltrated material

Question 13

What are common causes for angular cheiltis?

Answer 13

• bacterial or fungal
• denture can harbour bacteria
• if patient overclosed
• haematinics low
• not drying or cleaning face properly

Question 14

How do you manage xerostomia?

Answer 14

• change medication if possible
• salivary replacement
• salivary stimulants

Question 15

Give examples of salivary replacements.

Answer 15

• saliva orthana
• glandosane (v acidic)
• biotene
• bioXtra

Question 16

Give examples of salivary stimulants.

Answer 16

• sugar free chewing gum
• glycerine and lemon

Question 17

What is lichen planus?

Answer 17

• autoimmune reaction
• presents with erosive ulcers in oral mucosa and tongue

Question 18

What are bisphosphonates used for and how do they affect dentistry?

Answer 18

• used to improve bone density in treatment and prevention of osteoporosis, also used in the treatment of some cancers including breast and prostate
• can cause bone to become too dense that blood vessels cannot get through to heal extraction socket
• also inhibit bone turnover which prevents repair of microdamage

Question 19

What are the risk factors of MRONJ?

Answer 19

• extremes of age
• concurrent use of corticosteroids
• systemic condition affecting bone turnover
• malignancy and treatment of malignancy including chemo and radiotherapy
• previous diagnosis of BRONJ
• invasive dental procedures
• poor OH and perio disease
• alcohol and tobacco use

Question 20

Which jaw is MRONJ most common in?

Answer 20

Mandible

Question 21

What is post herpetic neuralgia?

Answer 21

• constant burning sensation in dermatome of affected branch
• majority resolve within 2 months however can persist for more than 2 years
• suicide risk
• incidence reduced with antiviral therapy and/or steroids

Question 22

What is the non-surgical treatment for post herpetic neuralgia?

Answer 22

• antidepressants
• gabapentin
• carbamazepine
• topical capsaicin
• transcutaneous electric nerve stimulation (TENS)

Question 23

What are the surgical options for managing post herpetic neuralgia?

Answer 23

• cryotherapy
• injection of alcohol or glycerol to nerve, or balloon placed at ganglion
• neurectomy
• avulsion of nerve

Question 24

What is burning mouth syndrome?

Answer 24

• signalling problem between mouth and brain
• no identifiable cause in 50% of patients
• can be caused by drugs, xerostomia, diabetes, hypothyroidism, allergy etc