DISORDERS OF THE ORAL CAVITY Flashcards
What are the different types of jaw cysts?
Odontogenic cysts - derived from dental structures - include: Radicular cysts Dentigerous or follicular cysts Eruption cysts Odontogenic keratocysts
Fissural cysts include:
Nasopalantine duct cysts
Nasolabial cyst/globulomaxillary cyst
Bone cyst
Ameloblastoma
What is the most common type of jaw cyst?
Radicular cysts
Where are radicular cysts of the jaw formed?
At the root apex of non-vital teeth
How do you treat radicular cysts of the jaw?
Often root canal surgery is needed to remove the dead necrosing pulp of the tooth. This allows the cyst to heal.
Where are most odontogenic keratocysts found?
Posterior ramus of the mandible. It may be large enough to compress the alveolar nerve causing anaesthesia of the chin.
How do you treat odontogenic keraotcysts?
Surgical removal. Important to note that recurrence is high.
Who do fissural cysts of the jaw tend to occur in?
Children. Most often presents as an infected cystic lesion.
What is an ameloblastoma?
Rare benign tumour of the ondogenic epithelium.
Where do ameloblastomas most commonly occur?
Usually a multilocular lesion at the angle of the mandible. Seen in the maxilla as well though.
What are the clinical features of an ameloblastoma?
Painless swelling Facial deformity if severe enough Pain if the swelling impinges on other structures Loose teeth Ulcers Periodontal (gum) disease
What are the radiological findings of ameloblastoma?
‘Soap bubble’ radiolucency
How do you treat an ameloblastoma?
Surgical removal of the tumour along with the teeth involved. Block resection of involved bone with margin of healthy tissue is advocated by some.
What are the infective causes of mouth ulcers?
Viral - herpes simplex, coxsackie virus
Bacterial - TB, syphilis
Fungal - candida
What are the systemic inflammatory diseases associated with mouth ulcers?
Behcet’s syndrome
Crohn’s disease
Coeliac disease and dermatitis herpetiformis
What are the vesiculobullous disorders associated with mouth ulcers?
Pemphigus
Pemphigoid
What are the two causes of mouth ulcers associated with malignancy?
Squamous cell carcinoma
Neutropenia
What is the virus most commonly associated with oral disease?
Herpes simplex type 1
What are the two main forms of oral disease associated with herpes simplex virus?
Herpetic gingivostomatitis - primary infection
Recurrent herpes simplex infection - virus lies dormant for several years
What are clinical features of herpetic gingivostomatitis?
Mouth ulcers affecting most of the gum and mouth
Odynophagia (pain on swallowing), which may lead to drooling
Fever
More often seen in children
How do you treat herpetic gingivostomatitis?
You tend not to need to. It is usually self-limiting within 10 days
Where can herpes simpex type 1 lie dormant after herpetic gingivostomatitis?
Trigeminal root ganglion
What can spark reactivation of herpes simplex type 1 infection in the mouth after years of dormancy, to produce vesicle formation and the familiar cold sore often found in the lips?
Sunlight
Stress
Intercurrent illness
What do we call cold sores caused by reactivation of herpes simplex virus?
Herpes labialis
How do we treat herpes labialis?
Topical aciclovir
What are vesiculo-bullous disorders?
Rare conditions where there is a loss of normal cell to cell adhesion as a result of autoimmune destruction, which results in blister formation and loss of epithelium leaving ulceration of mucosal surfaces.
What are the clinical differences between bullous pemphigoid and pemphigus vulgaris?
Bullous pemphigoid:
May present with itchy eczematous or urticarial rash prior to blistering.
Crops of tense blisters, filled with clear or blood-stained fluid. Lesions heal without scarring.
Localised or widespread.
Mucosal ulceration in 10- 25 per cent of cases.
Pemphigus vulgaris:
Usually first presents with ulceration of mucous membranes.
Flaccid blisters develop in the skin. These quickly rupture leaving painful erosions.
What are the autoantibodies directed towards in pemphigus vulgaris?
Desmogleins, protein that sticks cells together
What are the autoantibodies directed towards in bullous pemphigoid?
Mucosal basement membrane
What technique is used to visualise autoantibodies such as at anti-desmogleins found in pemphigus vulgaris patients?
Immunofluorescence
How do you manage patients with pemphigus vulgaris or bullous pemphigoid?
Steroids and immunosuppressants
What is the surprisingly common cancer of the mouth?
Oral squamous cell carcinoma
Did you know more people die in the UK of oral squamous cell carcinoma than of cervical cancer, yet it attracts relatively little publicity.
What are the clinical features of oral cancer?
Initially painless ulcer
May present as crater-like ulcer, white patch (leukoplakia) or a red area (erythroplakia)
Local invasion and destruction can lead to nerve damage
What is the most common site for oral cancers?
Floor of the mouth
Tongue
Retromolar area
Tonsillar area
How would you investigate someone who presents with an oral ulcer that has lasted more than 2 weeks?
Biopsy
Orthopantomogram (OPG) may reveal bony erosion or invasion
CT scan would help work out if cancer had spread to neck lymph nodes
What is the 5 year survival rate of patients with oral cancer with lymph node metastasis?
40%
What are the differential diagnoses for someone who presents with white patches in the mouth (leukoplakia)?
Congenital - sponge naevus
Infective - candidiasis, hairy leukoplakia
Immune - Lichen planus, discoid lupus erythematosus
Idiopathic
Squamous cell carcinoma
Who is more likely to develop candidal infection (thrush) in the mouth?
Neonates
Immunocompromised
Those taking broad spectrum antibiotics
What are the clinical features of oral candida infection?
Cream coloured plaques of fungi that can be wiped off the mucosa to leave an erythematous, sometimes bleeding, base.
How do you treat oral candida infection?
Topical antifungals such as:
Nystatin
Miconazole
What is hairy leukoplakia?
A condition that is characterised by irregular white patches on the side of the tongue and occasionally elsewhere on the tongue or in the mouth, caused by EBV. Strongly associated with HIV and can be the first sign of immunosuppression.
What is the most commonly seen skin disease in the ora cavity?
Lichen planus - immune mediated chronic inflammatory disorder. Cause is however unknown.
What are the classic clinical features of Lichen planus?
Reticulate or striate leukoplakia affecting the buccal mucosa
Erosive forms will produce large areas of ulceration, which are painful especially when exposed to spicy foods.
Associated skin lesions (itchy violaceous plaques) found on flexor surfaces of forearms and shins, and also on genitals can occur.
How do you treat Lichen planus?
Most patients will not requires treatment. In erosive forms it is important to rule out more sinister diagnosis such as SCC and topical steroids may be used for symptomatic relief.
What are the two forms of gingivitis based on severity?
Simple gingivitis
Acute necrotizing ulcerative gingivitis
What is the main cause of gingivitis?
Poor oral hygiene
What are the clinical features of simple gingivitis?
Painless, red swelling of the gum margin
Bleeds on contact such as brushing teeth
What are the clinical features of necrotizing ulcerative gingivitis?
Painful bleeding gums
Halitosis
Punched-out ulcers on the gums
How do we manage a patient with 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
