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BDS4 > Clinical SAQs > Flashcards

Clinical SAQs Flashcards

1
Q

What is MIH?

A

A developmentally derived enamel defect that involves hypomineralisation of one to four of the first permanent molars, often associated with similarly affected permanent incisors

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2
Q

How to manage MIH manifesting as mild enamel opacities without enamel breakdown on first permanent molars?

A

Prevention - high risk, fluoride toothpaste at least 1450ppm F, fissure seal with resin sealant, fluoride varnish 2.2% up to 4 times yearly, daily 225ppmF- rinse, investigate diet and advise
Manage sensitivity - casein phosphopetide amorphous calcium phosphate tooth mousse, fluoride mouthwash and varnish
May need nitrous oxide sedation to help with compliance because teeth may be tricky to anaesthetise

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3
Q

How to manage MIH manifesting as mild enamel opacities with enamel breakdown on first permanent molars?

A

Stabilisation - glass ionomer cement, consider orthodontic referral to discuss long term plans for retention of these molars and discuss extractions at appropriate age/stage of dental development
May need nitrous oxide inhalation sedation to help with compliance as teeth may be difficult to anaesthetise
Restorations - GIC or RMGIC not recommended in stress bearing areas and can only be used as intermediate restoration, composite resin is the material of choice, using LA and rubber dam

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4
Q

What clinical signs may suggest that a maxillary canine is ectopic?

A

Absence of maxillary canine in the appropriate position
Absence of canine bulge in the buccal sulcus
Deciduous upper canine still in place and not mobile
Protrusion of the lateral incisor
Other associated dental anomalies such as hypodontia, malformed teeth, delayed eruption of teeth, enamel hypoplasia

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5
Q

What special tests would be warranted if ectopic maxillary canine was suspected in a 13 year old patient?

A

Radiograph - maxillary standard occlusal or PA, and another radiograph to localise
CBCT can often give further information about its relationship with the adjacent teeth and any associated pathology

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6
Q

When would you consider the surgical removal of an ectopic canine?

A

When the tooth shows associated pathology such as a dentigerous cyst or root resorption
Where there is evidence of root resorption of the adjacent teeth caused by the impacted canine
When a patient is having orthodontic tx to align the adjacent teeth and it is thought to be in the way of the planned movement
If the patient chooses the option of an implant to replace the canine and avoid the need for extended orthodontic treatment

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7
Q

When would you consider leaving an impacted ectopic canine?

A

Where there is no pathology associated with the canine
The patient is not having orthodontic tx that requires its removal
There is a risk of damaging adjacent teeth by removing it
When a patient declines to have it removed
Where there are contraindications in the medical history to removal of the tooth

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8
Q

What are the various components of a removeable orthodontic appliance and what function does each one perform?

A

Active component - site of delivery of force to move a tooth/teeth
Retentive component - these components keep the appliance in the mouth
Anchorage component - provide resistance to unwanted tooth movement
Baseplate - holds all of the components together

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9
Q

What are the advantages to the design of an Adam’s clasp?

A

Provides retention and anchorage
Easy to adjust to anterior and posterior teeth
Versatile - auxiliary fittings include double clasps, hooks for elastics, tubes for headgear attachment

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10
Q

Retentive components

A

Adams clasp
Labial bow
South end clasp

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11
Q

When would you use an anterior bite plane?

A

To allow the posterior teeth to erupt while preventing the anterior teeth from erupting any more, as the posterior teeth erupt there is vertical development of the alveolus and the condyles will grow - to decrease an overbite
(only to be used in a patient who is still growing)

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12
Q

When would you use a posterior bite plane?

A

Allows anterior teeth to erupt further while the posterior teeth are prevented from further eruption - to increase a reduced overbite
(only to be used in a patient who is still growing)

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13
Q

Advantages of removeable appliances

A

Easier to maintain OH than with fixed
Create effective tipping movements of teeth
Can transmit forces to blocks of teeth
Cheap to make
Less chairside time than fixed
Good anchorage

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14
Q

Upper and lower 6s
Mineralisation commences
Eruption
Root formation completed

A

Birth
6-7 years
9-10 years

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15
Q

Upper As
Mineralisation commences
Eruption
Root formation completed

A

3-4 months in utero
7 months
1.5-2 years

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16
Q

Upper 3s
Mineralisation commences
Eruption
Root formation completed

A

4-5 months
11-12 years
13-15 years

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17
Q

Lower 5s
Mineralisation commences
Eruption
Root formation completed

A

2.25-2.5 years
11-12 years
13-14 years

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18
Q

Upper Ds
Mineralisation commences
Eruption
Root formation completed

A

5 months in utero
12-16 months
2-2.5 years

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19
Q

Lower 8s
Mineralisation commences
Eruption
Root formation completed

A

8-10 years
17-21 years
18-25 years

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20
Q

Name 2 conditions which may result in delayed eruption of primary teeth

A

Preterm birth
Nutritional deficiency
Turner syndrome
Down syndrome
Hereditary gingival fibromatosis

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21
Q

Name local conditions that might delay permanent tooth eruption

A

Supernumerary teeth
Crowding
Cystic change around tooth follicle
Ectopic position of the tooth germ

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22
Q

Name systemic conditions that may cause delayed permanent tooth eruption

A

Down syndrome/Turner syndrome - chromosomal abnormalities
Cleidocranial dysostosis
Nutritional deficiency
Hereditary gingival fibromatosis
Hypothyroidism
Hypopituitarism

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23
Q

Prevalence of hypodontia in the primary dentition

A

<1%

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24
Q

Prevalence of hypodontia in the permanent dentition, and which gender is it more common in?

A

3.5-6.5%
Females

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25
Q

What is infra occlusion and how is it graded?

A

Teeth that fail to maintain their occlusal relationship with opposing teeth, previously called submerged or ankylosed.
Most commonly affects deciduous lower molars.
Grade 1 - the occlusal surface is above the contact point of the adjacent tooth
Grade 2 - The occlusal surface is at the contact point of the adjacent tooth
Grade 3 - the occlusal surface is below the contact point of the adjacent tooth

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26
Q

What percentage of primary molars become infraoccluded?

A

8-14%

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27
Q

How would you manage an 11 year old with an infraoccluded lower second deciduous molar?

A

Take a radiograph to see if there is a permanent successor
If there is one, it is likely that this infraoccluded tooth will exfoliate at around the same time as the contralateral, when the permanent successor starts to erupt

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28
Q

When would you refer an infra occluded lower second molar for surgical removal?

A

When there is no permanent successor and the tooth will probably disappear below the gingival margin

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29
Q

If a tooth is infraoccluded below the gingival tissue, and there is a permanent successor what could have happened to the deciduous?
What needs to be considered after removal of the deciduous molar?

A

IT may have become ankylosed
Space maintenance for the permanent successor will need to be considered after extraction

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30
Q

12 year old patient has fallen and hit 11 and 21 which are now mobile and the crowns palatally displaced
What special tests would you carry out?

A

Periapical radiographs to check for root fractures
Sensibility testing

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31
Q

12 year old patient with 11 and 21 middle third root fractures. The teeth are mobile and the crowns palatally displaced. How would you treat this?

A

Splint the teeth using a flexible splint that allows physiological tooth movement
A wire splint that is bonded to the inured teeth and one healthy tooth on either side of the injured teeth used acid etched composite (easy to construct and well tolerated)
The splint must be kept in place for 4 weeks

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32
Q

Middle third root fracture of 11 in a 12 year old
Coronal portion of the pulp becomes non vital
How would you manage this?

A

Extirpate the pulp up to the fracture line
Fill the root canal with non setting calcium hydroxide to encourage barrier formation coronal to the fracture line
Change CaOH every 3 months until barrier is formed, at which point obturate the coronal root with GP and keep the tooth under review

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33
Q

How to treat dentoalveolar fracture?

A

Reposition and splint for 4 weeks

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34
Q

What is behavioural management?

A

A way of encouraging a child to have a positive attitude towards oral health and healthcare so that treatment can be carried out. It is based on establishing communication while alleviating anxiety and fear, as well as building a trusting relationship between the dentist/therapist and delivering dental care

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35
Q

Examples of behaviour management techniques

A

Tell show do
Positive reinforcement
Non-verbal communication
Voice control
Distraction

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36
Q

What drug is usually used for inhalational sedation?

A

Nitrous oxide

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37
Q

Contraindications to nitrous oxide

A

Sickle cell disease
Sever emotional disturbances
Chronic obstructive pulmonary disease
Cooperative patient
First trimester pregnancy
Drug related dependency

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38
Q

In a 15 year old with a retained, mobile upper C how would you determine whether the canine was present?

A

Clinical examination - angulation of the lateral incisors - a buccally placed ectopic canine might push the apex of the lateral palatally making the crown proclined
Palpation of the buccal sulcus and palate may reveal a bulge
Radiographs are the definitive method of determining presence

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39
Q

Explain how you would use an OPT and a PA to determine the position of an unerupted tooth

A

Parallax technique
When two views are taken with different angulations, any object that is further away from the tube will move the same direction as the tube
This can be applied in a horizontal or vertical direction
With these two views, OPT has been taken from a near horizontal position and the PA has been taken from a higher angulation
If the canine tooth appears lower on the OPT than the PA then it is palatally placed

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40
Q

Combinations of radiographs that can be used for parallax

A

Two PAs from different horizontal angulations
A PA and an upper occlusal
An upper occlusal and an OPT

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41
Q

What type of appliance are
Andresen
Frankel
Twin block
How do they work?

A

Functional appliances
They use, guide, or eliminate the forces generated by the orofacial musculature, tooth eruption and facial growth to correct a malocclusion

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42
Q

What age group are functional appliances most effective in?

A

Growing children
Preferably before the pubertal growth spurt as they use the forces of growth to correct the malocclusion

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43
Q

Which type of malocclusion is most successfully treated with functional appliance?
What skeletal effects are thought to occur?

A

Class II especially div 1
Can also be used to treat AOB and class III
Thought to provide a combination of skeletal and dental effects
The mandible is stimulated to grow and the glenoid fossa remodels forwards as the appliances pull the condylar cartilage forwards
It is also claimed that maxillary growth is inhibited

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44
Q

Name two skeletal and two dental changes that are reported to occur with the use of functional appliances

A

Skeletal
Restraint or redirection of forward maxillary growth
Optimisation of mandibular growth
Forward movement of glenoid fossa
Increase of lower facial height
Dental changes
Palatal tipping of upper incisors
Labial tipping of lower incisors
Inhibition of forward movement of maxillary molars
Mesial and vertical eruption of mandibular molars

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45
Q

What determines the response of a tooth when force is applied to it?

A

Magnitude and duration

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46
Q

What changes are seen in the PDL when orthodontic forces are applied to teeth?

A

Tension side - stretching of the PDL fibres and stimulation of the osteoblasts on the bone surface leading to bone deposits
Compression side - Compression of blood vessels, osteoclast accumulation which results in resorption of bone and formation of Howship lacunae into which fibrous tissue is deposited

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47
Q

Give 5 complications of ortho tx

A

RR
Enamel decal
Gingivitis
Trauma
Allergy
Relapse
Loss of tooth vitality

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48
Q

Tipping force

A

50-75g

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49
Q

Translational force

A

100-150g

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50
Q

Rotational force

A

50-100g

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51
Q

Extrusion force

A

50g

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52
Q

Intrusion force

A

15-25g

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53
Q

Name a commonly used index that categorises the urgency and need for orthodontic treatment?
How many components does it have and what grades does it incorporate?

A

IOTN Index of orthodontic treatment need, designed to establish the impact a malocclusion is likely to have on a patients dental health and psychological wellbeing
1 - dental health component 1-5, 1 being no and 5 being very great need for tx
2 - aesthetic component 1-10, 1/2 being no and 8/9/10 being significant need for treatment

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54
Q

When is it important to consider the aesthetic IOTN score?

A

When DHC gives a 3, 6 or above in aesthetic indicates a need for ortho treatment

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55
Q

Name 4 caused of a midline diastema

A

Physiological
Small teeth in larger maxilla
Missing teeth
Midline supernumerary, odontome
Proclination of upper segment
Prominent frenum

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56
Q

How would you determine the cause of a midline diastema?

A

History and examination
Look for a prominent frenum (pull the lip to put under tension and look for blanching of the incisive papilla), proclined upper incisors, size of the teeth in the segment
Radiographs will help confirm if any teeth are missing or the presence of supernumerary. A notch of the interdental bone between the upper centrals is another sign of prominent frenum

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57
Q

Once you have determined the cause of a midline diastema how should the patient be managed?

A
  • If upper 3s UE and diastema <3mm then reassess once 3s erupted
  • If upper 3s are UE and diastema >3mm then ortho may be needed when 3s erupt
  • If upper 3s are erupted the incisors require ortho or restorative to close gap
  • If there is a prominent frenum, refer for surgical opinion
  • If supernumerary refer for surgical removal
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58
Q

How common is CLP in western europe

A

1:700 births

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59
Q

At what age do most units carry out closure of the cleft lip?

A

3 months

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60
Q

At what age do most units carry out repair of cleft palate?

A

9-18 months

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61
Q

Name two dental anomalies that often occur in cleft patients

A

Hypodontia
Supernumerary
Delayed eruption
Hypoplasia

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62
Q

At what stage is ortho treatment needed in CLP?

A

Mixed and/or permanent dentition
Mixed dentition - proclination of the upper incisors may be necessary if they erupt in lingual occlusion, ortho expansion of collapsed arch and alignment of upper incisors is required prior to alveolar bone grafting
Permanent dentition - fixed appliances are usually required for alignment and space closure
Orthognathic surgery and associated ortho when growth completed
Pts classically have a hypoplastic maxilla with class III and orthognathic surgery is for improvement in aesthetics and function

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63
Q

What may need to be carried out to aid eruption of maxillary canine on the cleft side in CLP patients and when would this be done?

A

Alveolar bone grafting of cancellous bone from another site eg hip or tibia, to the cleft alveolus
age 8-11 - canine is 2/3rds root formed
Creates a one piece maxilla, gives the canine bone to erupt into, provides bone to support the alar base of nose, intact arch to allow ortho movement, aids closure of oronasal fistula

64
Q

Balancing extractions

A

Extraction of the same or adjacent tooth on the opposite side of the same arch

65
Q

Compensating extractions

A

Extraction of the same or adjacent tooth in the opposing arch on the same side

66
Q

Is the effect greater or less with the premature loss of a deciduous first molar than with a canine?

A

A centreline shift will occur to a lesser degree with the unilateral loss of a deciduous first molar than a canine

67
Q

What would you recommend in a crowded mouth required unilateral loss of an upper canine?

A

The unilateral loss of a canine should be balanced as the correction of a centreline discrepancy is likely to need fixed appliance and prevention is preferable

68
Q

What is the effect if premature loss of a deciduous second molar?

A

Associated with forward migration of the first permanent molar, this is greater if the deciduous second molar is lost before the eruption of the first molar, so if possible delay until the first permanent molars are in occlusion

69
Q

Do you compensate or balance the loss of deciduous second molar?

A

Neither

70
Q

AOB can occur with which types of malocclusion?

A

Class I, class II or class III

71
Q

Simple classification of the causes of an anterior open bite

A

Skeletal causes - increased lower anterior face height or increase MMPA, or localised failure of alveolar growth
Soft tissue causes - endogenous tongue thrust
Habits - digit sucking

72
Q

AOB caused by one factor is relatively straightforward to treat, which is it?

A

Digit sucking

73
Q

What occlusal features may you see in a digit sucking habit?

A

AOB
Proclined upper incisors
Retroclined lower incisors
Buccal segment unilateral crossbite with mandibular displacement

74
Q

Management of geographic tongue

A

Take a thorough history and examination
Does not usually require treatment
Reassure pt that lesion is benign
Advise pt to avoid certain foods
Occasionally benzydamine mouthwash

75
Q

What will patients report if they have geographic tongue?

A

Changes in site, shape, size of the lesion
Discomfort or burning sensation, often in association with acidic or spicy food
Some cases asymptomatic

76
Q

50 year old patient presents with a brown lesion on the palatal mucosa - what characteristics would make you think it was a malignant melanoma?

A

Location - most common on the palate
Age - high risk 40-60
Colour - usually dark brown or black
Often asymptomatic
Firm and rubbery to touch
May ulcerate
May bleed or be sore - late presentation

77
Q

Prognosis for malignant melanomas

A

Poor
Median survival around 2 years

78
Q

What could a single brown lesion on the palate be?

A

Malignant melanoma
Melanocytic nevus
Melanotic macule
Racial pigmentation
Amalgam tattoo

79
Q

What could multiple small brown lesions in the mucosa be?

A

Melanocytic naevi
Peutz-jehgers syndrome
Addison’s disease
Melanocytic macules associated with HIV

80
Q

Common causes of a dry mouth

A

Developmental - aplasia
Radiotherapy
Drug side effects
Salivary gland disease - sjogrens, sarcoidosis, HIV
Medical conditions causing dehydration - renal disease, diabetes
Alcohol
Mouth breathing

81
Q

How to determine the cause of dry mouth?

A

Thorough medical history
Blood tests - autoimmune screen, glucose for diabetes
Imaging - CT or MRI
Biopsy

82
Q

Dental concerns in dry mouth

A

Increased risk of caries
Candidal infection may be present and require treatment

83
Q

Four possible aetiological factors of recurrent aphthae

A

Genetic predisposition
Immunological abnormalities
Haematological deficiencies
Stress
Hormonal changes
GI disorders
Infections

84
Q

Types of recurrent aphthae

A

Minor <5mm diameter, one or multiple affecting non keratinised epithelium ONLY
Major >1cm diameter, anywhere in the mouth
Herpetiform - multiple small aphthae 1-2mm, may coalesce to make larger areas of ulceration, on non keratinised mucosa

85
Q

Treatment for recurrent aphthae

A

Try to determine underlying cause and treat this
OTC Igloo bonjela etc, benzydamine mouthwash
If severe disabling - topical steroids betamethasone and beclomethasone
Tetracycline mouthwash
Chlorhexidine mouthwash

86
Q

What is angular chelitis?

A

Inflammation of the skin and labial mucous membrane at the commissures of the lips

87
Q

How does angular chelitis differ from actinic chelitis?

A

Actinic chelitis is a premalignant condition in which keratosis of the lip is caused by UV radiation from sunlight

88
Q

List three predisposing factors for angular chelitis

A

Dentures and denture related stomatitis
Nutritional deficiencies eg Iron
Immunocompromised
Decreased vertical dimension resulting in infolding of the tissues at the corner of the mouth, allowing skin to become macerated

89
Q

Which organisms commonly cause angular chelitis?

A

Staphylococcus aureus
Candida albicans

90
Q

What medicaments can be used to treat angular chelitis?

A

Fusidic acid cream
Miconazole gel

91
Q

5 ways candidal infection may present to a dentist

A

Acute pseudomembranous candidiasis
Angular stomatitis
Acute atrophic candidiasis
Chronic hyperplastic candidiasis
Chronic mucocutaneous candidiasis

92
Q

What does acute pseudomembranous candidiasis look like in the mouth?

A

White patches on the mucosa that can be wiped off, leaving erythematous mucosa underneath

93
Q

Smears are often taken from acute pseudomembranous candidiasis. How are the smears treated and what do they show?

A

Smears are gram stained and show a tangled mass of gram positive fungal hyphae, leukocytes and epithelial cells

94
Q

Name two -azole type drugs and two other drugs which are not azoles, used to treat candidal infections

A

Fluconazole
Miconazole
Nystatin
Amphotericin

95
Q

Name common types of white patches and what might cause them

A

Frictional keratosis - friction
Candidal infections - candida albicans
Linea alba - trauma from cheekbiting
LP - unknown
Lichenoid reactions - amalgam
Fordyce spots - developmental

96
Q

What would you call a white patch that cannot be characterised clinically or pathologically as any other disease and which is not associated with a causative agent except tobacco?

A

Leukoplakia

97
Q

Clinical appearance types of leukoplakia

A

Homogenous leukoplakia
Nodular leukoplakia
Speckled leukoplakia

98
Q

What type of biopsy would be appropriate for a leukoplakia?

A

Incisional or brush biopsy

99
Q

How are leukoplakias treated?

A

Removal of causative agent
Surgical removal
Photodynamic therapy
Specialist referral
Regular review and biopsy as appropriate
Retinoids

100
Q

Name 5 causes of dry mouth

A

Sjogren’s
Anxiety
Drugs with dry mouth side effect such as diuretics
Medical conditions causing dehydration such as diabetes
Mumps or HIV infection
Radiotherapy in the region of salivary glands

101
Q

What is the different between primary and secondary Sjogren’s disease?

A

Primary is dryness of mouth and eyes, secondary is dryness with associated connective tissue disease such as rheumatoid arthritis or systemic lupus erythematous

102
Q

What type of biopsy is often carried out to diagnose Sjogren’s and why?

A

Labial salivary gland biopsy
Minor glands are usually involved at a microscopic level even though they might not be enlarged

103
Q

What microscopic features would a biopsy showing Sjogren’s show?

A

Focal collections of lymphoid cells adjacent to BVs
Greater the number of foci the worse the disease
Acinar atrophy

104
Q

What other investigations could be carried out to diagnose Sjogren’s?

A

Blood tests - autoantibody screen for ANA Anti Ro and Anti La
Parotid salivary flow rate
Schirmer test
Sialography

105
Q

Oral signs and symptoms acute leukemia

A

Gingival hypertrophy and bleeding

106
Q

Oral signs and symptoms AIDS

A

Kaposi’s sarcoma

107
Q

Oral signs and symptoms rheumatoid arthritis

A

Recently developed AOB

108
Q

Oral signs and symptoms HIV carrier

A

Hairy leukoplakia

109
Q

Oral signs and symptoms Melkersson rosenthal syndrome

A

Fissured tongue

110
Q

Oral signs and symptoms Peutz jehgers syndrome

A

Perioral pigmentation

111
Q

Oral signs and symptoms Gorlin goltz syndrome

A

Multiple odontogenic keratocystic tumours

112
Q

Oral signs and symptoms Crohn’s disease

A

Cobblestoned buccal mucosa

113
Q

Oral signs and symptoms measles

A

Koplik’s spots

114
Q

Oral signs and symptoms marfan syndrome

A

High arched palate

115
Q

Oral signs and symptoms syphilis

A

Moon molars

116
Q

Oral signs and symptoms cleidocranial dystosis

A

Multiple supernumerary teeth

117
Q

Oral signs and symptoms lichen planus

A

Wickham’s striae

118
Q

Erythroplasia

A

Red lesion of unknown cause
Cannot be characterised clinically or pathologically

119
Q

What is seen histologically with erythroplasia?

A

Can be dysplasia, carcinoma in situ, carcinoma

120
Q

Order of malignant potential highest to lowest
White sponge nevus
Erythroplasia
Leukoplakia
Speckled leukplakia

A

Erythroplasia
Speckled
Leukoplakia
White sponge nevus

121
Q

Kaposi’s sarcoma, oral lesions
What colour are they and are they localised or generalised?

A

Red/purple
Localised

122
Q

Haemangioma oral lesions
What colour are they and are they localised or generalised?

A

Red/purple
Localised

123
Q

Amalgam tattoo oral lesions
What colour are they and are they localised or generalised?

A

Black
Localised

124
Q

Addison’s disease oral lesions
What colour are they and are they localised or generalised?

A

Brown
Localised to certain areas

125
Q

Irradiation mucositis oral lesions
What colour are they and are they localised or generalised?

A

Red
Generalised in the region of irradiation

126
Q

45 year old presents with a lump in the palate, give four possible diagnosis

A

Torus palatinus
Unerupted tooth
Dental abscess
Papilloma
Neoplasm

127
Q

8 features that one need to determine in a patient presenting with pain

A

Site
Onset
Character
Radiation
Associated symptoms
Time duration of pain
Exacerbating factors
Severity
Effect on sleep

128
Q

Which features would make you think a patient had atypical/idiopathic facial pain?

A

Severe
No associated pathology
Investigations do not show anything
Long standing and continuous
Conventional analgesics provide no relief

129
Q

What treatment is there for atypical/idiopathic facial pain?

A

Tricyclic antidepressants
Anticonvulsants
CBT
Stress management

130
Q

30 year old presents with weakness on the left side of the face
Name two intracranial and two extracranial possible causes?

A

Intracranial:
Stroke
Multiple sclerosis
Extracranial:
Bell’s palsy
sarcoidosis

131
Q

How will you tell whether a nerve lesion causing a facial weakness has an upper motor neuron cause or a lower motor neuron cause?

A

Lower motor neuron lesion - the patient cannot wrinkle their forehead on the affected side
Upper motor neuron lesion they retain movement of their forehead
Ask patient to raise eyebrows

132
Q

Ramsay hunt syndrome
And treatment indicated

A

Herpes zoster infection of the geniculate ganglion which produces a facial palsy and vesicles in EAM region and palate
Aciclovir
(short course high dose steroids)

133
Q

4 causes of localised gingival swellings

A

Periodontal abscess
Fibrous epulis
Papilloma
Tumour

134
Q

What are the signs and symptoms of primary herpetic gingivostomatitis?

A

Multiple vesicles in the mouth which burst and leave painful ulcers
Often gingivitis
Patients feel unwell
Fever/malaise/ cervical lymphadenopathy

135
Q

Causative agent of primary herpetic gingivostomatitis

A

Herpes simplex virus

136
Q

How is primary herpetic gingivostomatitis treated?

A

Rest, soft diet, fluids, analgesics
Chlorhexidine or tetracycline mouthwash to prevent secondary infection of the ulcers
Aciclovir in severe cases or medically compromised pts

137
Q

After primary herpetic gingivostomatitis, how is this followed by recurrent herpes labialis?

A

Virus remains dormant in the trigeminal ganglion and can be reactivated by factors
- Sunlight
- Stress
- Menstruation
- Immunosuppression
- Common cold
- Fever

138
Q

Where does herpes zoster virus lie latent?

A

Dorsal root ganglion

139
Q

Herpes labialis

A

Lesions at mucocutaneous junction of the lips
Often prodromal itching, prickling
Papule - vesicle - burst - scab
Usually heal without scarring 7-10 days
Antiviral aciclovir cream in the prodromal phase may prevent/speed healing

140
Q

Diagnostic test for Sjogren’s

A

Autoantibody blood tests

141
Q

Diagnostic test for dental abscess causing submandibular space infection

A

Culture and sensitivity

142
Q

Diagnostic test for benign mucous membrane pemphigoid

A

Immunohistochemistry

143
Q

Diagnostic test for burning mouth

A

Full blood count

144
Q

Diagnostic test for glandular fever

A

Paul-bunnell test

145
Q

Diagnostic test for giant cell arteritis

A

Erythrocyte sedimentation test

146
Q

Diagnostic test for acute pseudomembranous candidiasis

A

Smear

147
Q

Diagnostic test for sarcoidosis

A

Serum angiotensin converting enzyme

148
Q

Diagnostic test for trigeminal neuralgia

A

History and clinical examination

149
Q

Diagnostic test for submandibular duct salivary calculus

A

Lower standard occlusal radiograph

150
Q

What special investigation would you consider with younger trigeminal neuralgia patients and why?

A

MRI of the brain
May be presenting feature of multiple sclerosis

151
Q

Drugs which can cause lichen planus

A

Beta blockers
NSAIDs
Gold
Penicillamine
Some tricyclic antidepressants

152
Q

Oral signs of coeliac disease

A

Oral ulceration
Angular chelitis
Glossitis

153
Q

Crohns disease

A

Chronic granulomatous disease
May affect any part of the GI tract, most commonly ileum

154
Q

Oral signs of crohns

A

Mucosal tags
Cobblestone mucosa
Lip swelling
Oral ulceration

155
Q
A

BDS4 (18 decks)

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