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Intro to OM Flashcards

1
Q

BISOM

A

The British & Irish Society of Oral Medicine

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2
Q

Mucosal disease

A
  • white patches
  • red patches
  • brown patches
  • ulcers
  • blisters
  • lumps and bumps
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3
Q

Salivary gland disease

A
  • hyposalivation
  • hypersalivation
  • swellings
  • lumps and bumps
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4
Q

Facial/ Unexplained oral pain

A
  • trigeminal neuralgia
  • neuropathic pain
  • other non- dental pain
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5
Q

How to work out causes of ulcers?

A
  • history
  • system inquiry
  • examination
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6
Q

Oral Ulcers causes

A
  • traumatic
  • drug induced (iatrogenic)
  • metabolic/ nutritional
  • neoplastic
  • infective
  • inflammatory
  • immunological/ inflammatory
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7
Q

Mucosa Colour

A
  • keratinisation
  • vasculature
  • inflammation
  • melanin
  • candida
  • exogenous factors
  • epithelial thickness
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8
Q

White patches

A
  • abnormal/ increased keratin
  • increased epithelial thickness
  • candida
  • keratotic tissue cannot be wiped away
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9
Q

Candida

A
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10
Q

Risk Factors for Oral Candida Infection

A
  • immunocompromised - medication, medical condition
  • dentures: OH
  • smoking
  • inhaler use
  • thrush/ yeast/ fungal infection
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11
Q

Management for Oral Candidiasis

A

Anti-fungal therapy
- Fluconazole
- Miconazole
- Nystatin

Local Measures
- rinse after inhalers
- use a spacer
- denture hygiene
- smoking cessation

Chronic problem, hence will return if local factors not treated

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12
Q

Traumatic keratosis

A
  • increased keratin at site of trauma
  • encourage smoking cessation
  • get a photograph
  • if high risk, refer to secondary care
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13
Q

Oral Lichen Planus/ Oral Lichenoid reaction Classification

A
  • reticular
  • atrophic
  • papular
  • erosive
  • plaque like
  • bullous
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14
Q

OLP

A
  • CD8+ T cell mediated destruction of basal keratinocytes
  • chronic inflammatory condition
  • may be autoimmune disease but with no auto- antigen detected
  • may be asymptomatic/ present as burning and stinging sensation
  • malignant potential 1% over 10 years
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15
Q

Causes of OLP/ OLR

A
  • ask about systemic symptoms/ recent cancer therapy
    LUPUS and Graft vs Host disease

Drugs causing OLR
- Antihypersentives
- Antimalarias
- NSAIDs (non-steroidal anti-inflammatory drugs)
- Allopurinol
- Lithium

DM causing OLR
- amalgam
- gold
- nickel
- composite resin

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16
Q

OLP/ OLR Management

A

Symptomatic relief
- simple mw (HSMW)
- local anesthetic topical (Benzydamine/ Lidocaine)
- avoid spicy food and drinks (trigger factors)
- Steroid mw (Betamethasone mw, Beclomethasone inhaler, hydrocortisone oromucosal tablets)
- replace restorations
- referral for biopsy, increased cancer risk, stop cause of OLR

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17
Q

2 viruses commonly associated with Hairy Leukoplakia?

A
  • non- removable white patch
  • most common on lateral borders of tongue
  • acanthotic and para-keratinised tissue, finger-like projections of keratin
  • EBV (Epstein Barr Virus- Human Herpes virus 4)
  • immunocompromised
  • 20-25% of patients with HIV as tx improved
  • can be seen in non-HIV immunocompromised
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18
Q

Leukoplakia

A
  • diagnosis of exclusion
  • no obvious cause for white patch
  • malignant potential
  • dysplastic - abnormal cellular changes -> malignancy
  • require biopsy for histological examination
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19
Q

Red patches

A
  • atrophy (thinner tissues)
  • inflammation

Red patch with no clear cause has a high likelyhood of being dysplastic/ malignant

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20
Q

Classification of OLP (RAPEPB)

A
  • reticular
  • atrophic
  • papular
  • erosive
  • plaque- like
  • bullous
21
Q

Erythematous Candidiasis

22
Q

Desquamative gingivitis

23
Q

Granulomatosis with Polyangiitis (GPA)

A
  • blood vessels become inflammed
  • known as “Wegner’s granulomatosis”
  • systemic vasculitis
  • fever & weight loss
  • 92% have ear, nose, throat manisfestations
  • potentially fatal
  • manage with immunosuppresants
24
Q

Erythroplakia

A
  • velvety, firey, red patch
  • DOE
  • most will have dysplasia/ malignancy
  • very high malignancy transformation
  • URGENT REFERRAL
25
Orofacial Granulomatosis/ Oral Crohn's (OFG)
- non- necrotising granuloma formation - consider Gi investigation
26
Management of OFG
- topical steroids - avoidance certain diets - intralesional steroid Biologics for Crohn's - Infliximab - Adalimumab (anti-TNF) - Ustekinumab (human monoclonal antibody, Anti IL21/23) - Vedolizumab (Anti-a4b7)
27
Erythroleukoplakia
- speckled white and red patches
28
Management of Erythroleukoplakia
HIGH RISK - refer to secondary care urgently - aetiology same as leukoplakia/ erythroplakia
29
Things to assess
- location - colour - homo/ heterogeneity - induration (hard/ soft) - raised/ flat - texture - is it wipeable - symmetry Take a photo of it
30
General Approach
- through MH and SH - through exam - identify cause - reverse reversible (rubbing dentures/ teeth/ poor OH) - photography - if no clear cause/ pt has risk factors, refer - red patches with no known cause (high suspicion)
31
What is an ulcer?
A breach in the mucosa - localised defect, where a destruction of epithelium exposing underlying connective tissue
32
Causes of Oral Ulceration
- traumatic - metabolic/ nutritional - allergic/ hypersensitivity - infective - inflammatory - immunological - drug induced (iatrogenic) - neoplastic - idiopathic
33
Clues to the cause of ulcer?
- site - onset - duration - number - texture - appearance - size - pain - predisposing factors - relieving factors
34
Traumatic ulcers
- white keratotic borders - clear causative agent -> fractured cusp - surrounding mucosa feels normal - ulcer soft - chemical burns, such as etch?
35
Aphthous ulcers
- most common ulcerative condition - painful - red border - yellow/ white centre - multiple triggers: stress, trauma, allergy, sensitivity 3 types - Major: greater than 1cm, longer healing time - Minor: less than 1cm, heals 2-3 weeks - Herpetiform: multiple small ulcers that may coalesce
36
Types of Recurrent Aphthous Stomatitis
- Major: >1cm, longer healing time - Minor: < 1cm, healing time 2-3 weeks - Herpetiform: multiple small ulcers that may coalesce
37
Causes of RAS
- metabolic and nutritional - children/ teenagers: associated with growth - adults with occult GI/GU pathology - malnourishment - anemia
38
Blood test for Anaemia
- Full blood count - Urea & electrolytes, FBC, Liver Function test - FBC, Anti- nuclear Antibodies (ANA), Coeliac screen - FBC, Vit. B12, Folate, Ferritin, CS - FBC, Erythrocyte Sedimentation Rate, HIV screening
39
Inflammatory/ Immunological Ulcers
- Behcet's- mouth, skin, genitals, eyes - Necrotising sialometaplasia (picture) - LP - Vesiculobullous disease CT disease - Systemic Lupus Erythematous - Rheumatoid Arthritis - Scleroderma
40
Gastrointestinal pathology is associated with oral ulcers, what could you ask the patient to enquire into any GI symptoms?
Gut - abdominal pain - PR blood/ mucus - altered bowel motion - unintentional weight loss CTD - joint pain - photosensitive rashes - xeropthalmia/ xerostomia (oral dryness) - fatigue
41
Infective ulcers
42
Primary Herpes Simplex Virus
- affect children between 2-5 - associated with fever - headache, malaise, dysphagia, cervical lymphadenopathy - short lasting vesicle on tongue, lips, buccal, palatal, gingival -> form ulceration
43
Varicella- Zoster virus
- primary VZV infection (chicken pox) - virus remains in sensory ganglion - reactivation of latent virus resulting in VCZ infection (shingles) - reactivation due to immunicompromised/ acute infection - liaise with GP to provide analgesia/ difflam if painful
44
Iatrogenic Ulcers
- chemotherapy - radiotherapy - GvHD - Drug induced: K+ channel blockers, bisphosphonates, NSAIDs, DMARDs
45
Which of these features of an ulcer would make it higher risk for oral cancer?
- exophytic: grow outwards of mucosal surface - rolled borders - raised - hard to touch - non movable - not always painful - sensory disturbance
46
Oral Ulceration Local Management
1. sus then refer urgently to OMFS 2. reverse the reversible 3. refer to GP for FBC/ coeliac/ Haematinics if aphthous appearance 4. simple mw (HSMW) 5. antiseptic MW (hydrogen peroxide/ CHX/ Doxycycline) 6. Local anaesthetic (Benzydamine spray/ mw) 7. Steroid mw (Betamethasone) 8. Steroid inhaler (Beclomethasone) 9. onward referral
47
Pain in OM
48

Oral Medicine (24 decks)

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