Generic OM questions Flashcards
What virus is associatd with hairy leukoplakia
epstein barr virus
-Typically in immunocompromised
-Seen in 20-25% of patients with HIV
What is hairy leukoplakia, where is it common, what does it look like and is it malignant
Non-removable white patch
Most common on lateral borders of the tongue
Acanthotic and para-keratinised tissue, finger-like projections of para keratin
Has malignant potential
Can be dysplastic – A group of abnormal cellular changes associated with malignancy
What is Erythroplakia, how is it diagnosed and is it malignant
Velvety, firey, red patch
Diagnosis of exclusion
Cannot be attributed to another disease
Most will have dysplasia or malignancy
Very high malignant transformation
If you find something suspicious in the patients mouth what would want to assess
Location
Colour
Homo/heterogeneity
Induration (does it feel hard or soft)
Raised or flat
Texture
Is it wipeable
Symmetry
What is an ulcer
Localised defect, where there is destruction of epithelium exposing underlying connective tissue
What would be signs that an ulcers cause is traumatic
White (keratotic) borders
Clear causative agent (e.g. fractured cusp)
Surrounding mucosa normal and ulcer soft
What would a neoplastic ulcer look like
Exophytic
Rolled borders
Raised
Hard to touch
Non Moveable
Not always painful
Sensory disturbance
What could metabolic and Nutritional cause of ulcers be
Aphthous ulceration
Children/teenagers - associated with growth
Adults with occult GI/GU pathology
Malnourishment of any cause
Anaemia
What could Inflammatory/Immunological cause be of ulcers
Behcet’s – Aphthous appearance
Necrotising sialometaplasia
Lichen Planus
Vesiculobullous Disease
Connective Tissue Disease: Systemic Lupus Erythematous, Rheumatoid Arthritis, scleroderma
What could infectives causes of ulcers be
Primary or recurrent herpes simplex virus infection
Varicella-zoster virus
Epstein-Barr virusCoxsackie virus
EchovirusTreponema pallidum
Mycobacterium tuberculosis
Chronic mucocutaneous candidiasis
HIV
What could latrogenic causes of ulcers be
Chemotherapy
Radiotherapy
Graft versus Host Disease
Drug Induced Ulceration
-Potassium channel blockers, bisphosphonates, NSAIDS, DMARDs
What is the management of oral ulceration
If suspicious of malignancy – REFER Urgently to OMFS
Refer to GP for FBC/Haematinics/Coeliac Screen – if aphthous appearance
1)Simple mouthwash (HSMW )
2)Antiseptic mouthwash (hydrogen peroxide or CHX or doxycycline)
3)Local anaesthetic (Benzydamine Spray or Mouthwash)
4)Steroid mouthwash (Betamethasone)
5)Steroid Inhaler (Beclometasone)
6)Onward referral
What ulcers only happen on unattached oral mucosa
Aphthous ulcers
What ulcers appear on attached pral musoca
Herpetic ulcers
