9.3 Clinical cases

Question 1

Describe anaphylaxis.

Answer 1

• Type I hypersensitivity reaction
• Urgent treatment with IM adrenaline
• Causes an itchy rash, vomiting, light headedness, throat or tongue swelling, shortness of breath and low BP

Question 2

Describe angiodema.

Answer 2

• Swelling underneath the skin, caused by an immune response.
• Most commonly affects the hands, feets, area around the eyes, lips, tongue and genitals.
• Similair to anaphylaxis
• Misfiring complement cascade
• Can be congenital or acquired

Question 3

What can trigger angiodema?

Answer 3

• Food such as nuts, shellfish, milk and eggs
• NSAIDs
• Antibiotics
• ACE inhibitors (‘prils’)
• Angiotensin receptor blockers (‘sartans’)
• Insect bites and stings
• Latex

Question 4

Describe lichenoid reactions.

Answer 4

• Type IV (delayed) hypersensitivity reaction
• Immune mediated reaction
• Triggered by drug exposure or other agents
• E.g. reaction to amalgam restoration
• E.g. drug reaction to naproxen

Question 5

What autoimmune diseases may present with oral manifestations?

Answer 5

• Sjogren’s
• Lupus
• Pemphigus and pemphigoid (blistering disorders)
• Rheumatoid arthritis
• Scleroderma

Question 6

Desribe pemphigus vulgaris.

Answer 6

• Autoimmune blistering condition
• Affects the skin and mucosa
• Shallow blisters
• Epithelial layers seperate
• Painful
• Can affect the eyes, risk of sight loss

Question 7

Describe bullous pemphigoid.

Answer 7

• Similair presentation to pemphigus
• Split of epithelial layers is deeper, affects the epidermis and dermis, creating tense blisters that do not break as easily

Question 8

Describe lupus.

Answer 8

• Systemic lupus erythematous (SLE)
• Lifelong condition causing inflammation of the joints, skin and other organs
• Discoid lupus erythematosus (DLE) is a form that only affects the epithelia and mucosa
• ‘Butterfly rash’
• Hair follicles damaged

Question 9

Describe Sjogren’s syndrome.

Answer 9

• Affects salivary and lacrimal glands
• Xerostomia
• Caries, perio, issues with mastication, swallowing and speech
• Dry eyes, burning and itchiness
• Sialography can be used, hole appearance due to empty acini (A = healthy, B-E = grades of Sjogren’s)
• Scintigraphy also used

Question 10

Describe rheumatoid arthritis.

Answer 10

• Autoimmune connective tissue disorder
• Affects joints, rarely affects TMJ
• Linked to Sjogren’s

Question 11

Describe scleroderma/systemic sclerosis.

Answer 11

• Group of autoimmune diseases
• Reduced mouth opening
• Affects multiple connective tissues, blood vessel, facial tissues, stiff inelastic tissues
• Progressive fibrosis
• Progressive trismus and oral opening restricted

Question 12

Describe reticular oral lichen planus.

Answer 12

• Chronic inflammatory condition affecting the mucous membrane
• Unkown cause
• Lacy pattern, white patches in the mouth
• Symmetrical

Question 13

How can HPV manifest orally?

Answer 13

• Warts of the skin and mucosa
• HPV-16 and -18 are linked to malignancy
• Tonsillar and orophayngeal cancer

Question 14

How quickly should patients with suspected oral cancer be seen after referral?

Answer 14

Should be seen within 2 weeks.

Question 15

Describe the range of dysplasia.

Answer 15