Intro To Oral Med Flashcards
Describe fordyce spots and where it’s usually located in the oral mucosa
Sebaceous glands, yellowish bumps, no associated pathology
Buccal mucosa and lips
Percentage of adults experiencing fordyce spots
60-75%
Describe linea alba, it’s histological features and where it usually occurs in the oral mucosa
Horizontal, asymptomatic, white lesion
Histologically: hyperkeratosis, prominent or reduced granular layer, Acanthosis
Occurs along the occlusal plane
Geographic tongue is also known as __________or___________
Benign migratory glossitis or Erythema migrans
Percentage of population affected with geographic tongue
3%
What is geographic tongue? Symptoms if any
Loss of filiform papillae, areas of tongue atrophy and hyperkeratinisation
Comes and goes, changes appearance
Can affect other areas of oral mucosa
Asymptomatic: sometimes sensitive to hot and spicy foods and toothpaste
What should a person with geographic tongue do when they experience sensitivity to hot and spicy foods and toothpaste?
Avoid trigger foods and use SLS free toothpaste
Describe fissured tongue
Variation of normal anatomy, canoccur later in life, commonly presents with geographic tongue
Treatments/ advice for fissured tongue individuals
No treatment necessary
Encourage good oral hygiene, light tongue brushing
Describe black hairy tongue
Asymptomatic
Hyperplasia of filiform papillae
Buildup of commensal bacteria and food debris
Pigment inducing fungi and bacteria
Treatment/ Management of black hairy tongue
Reassure
Stop smoking
Stay hydrated
Light tongue brushing/ exfoliating tongue surface
Eating fresh pineapple
Causes of black hairy tongue
Specific cause is unknown, associated with smoking, antibiotics, chlorhexidine mouthwash, poor oral hygiene
Describe desquamative gingivitis
Full thickness erythema of Gingiva
Not a diagnosis
Associated with lots of conditions
_______ can exacerbate desquamative gingivitis but not cause it
Plaque
Describe bony exostosis, common association, and different names depending on their locations
Benign overgrowth of calcified bone associated with parafunction
Can interfere with denture placement, typically painless, may be more prone to ulceration
Palate: Torus palatinus
Mandible: torus mandibularis (linguals typically)
Buccal alveoulus
Describe physiological pigmentation and what conditions to consider
Normal, more common in non white ethnicities, due to increased melanin pigmentation, can make diagnosis musical disease more challenging
Consider: Addisons disease, smokers Melanosis, drug related pigmentation
What is pain and what are the 3 types of pain
Pain are signals to the brain
Nociceptive pain, inflammatory pain and pathological pain
Describe nociceptive pain
High threshold pain, putting hand on hot pan, producing a withdrawal reflex
Describe inflammatory pain
One of the cardinal features of inflammation , for example pain in irreversible pulpties
Describe pathological pain
Maladaptive due to abnormal functioning nervous system, seem in oral dysarsthesia, often.no cure
Approach to pain in oral medicine
Taking history (pain, medical, social)
exclude dental pathology ( do examination, radiographs, pulp vitality, joint clinic with restorative dentistry)
Do further investigations ( blood investigations, cranial nerve exam, MRI)
Examples of non odontogenic intra oral pain
Mucosal:
Ulcers
Lichen planus
Vesiculobullous disorders
Salivary gland pain
Neuropathic pain
Trigemincal neuropathic pain
Persistent idiopathic dentoalveolar pain
Burning mouth syndrome- oral dysaesthesia
Describe burning mouth syndrome
Pain/ burning sensation
Altered sensation
Perception of dry or excess saliva
Common on tongue
Normal muscosa
Discompfort as apposed to pain
Doesn’t follow anatomical boundaries
Describe trigeminal neuralgia
Electric shock like/ shooting/ stabbing pain
Unilateral
Severe 10/10
Short lasting
Episodic
Rarely has concominatpain
May or may not have triggers
Management to trigeminal neuralgia
Medication: tricyclic antidepressants, anti epileptics
Coping stategies: distraction, meditation, exercise
What is an ulcer
Breach in mucosa
Define oral ulceration
Localised defect, where there is destruction of epithelium exposing underlying connective tissue
Common causes of oral ulceration
Trauma
Metabolic/ nutritional
Allergy/hypersensitivity
Infective
Inflammatory
Immunological
Drug induced
Neoplastic
Idiopathic
Describe this lesion
Traumatic ulcer
White keratitis borders
Surrounding mucosa normal and ulcer soft
Describe apthlous ulcers
Most common ulcerative conditions
Painful
Red border, yellow white centre
Affects 20%
Types of recurrent aphthous stomatitis
Major- > 1cm, long time to heal
Minor: < 1cm, takes 2-3 weeks to heal
herpetiform -multiple small ulcers that may coalesce
Similarities and differences between causes of metabolic/ nutritional ulcers in children/ teenagers and adults
Children/Teenagers: associated with growth
Adults: GI/ GU pathology
Both may be caused by malnourishment, anemia
Blood tests to investigate anaemia
FBC, VitB12, Folate, ferritin, coeliac screen
Types of inflammatory/ immunological ulcers
Behcet’s : Apthous appearance, mouth, skin, genitals, eyes
Necrotising sialometaplasia
lichen planus
Vesicobullous disease
Connective tissue disease: systemic lupus erythematous, rheumatoid arthritis, scleroderma
Primary herpes simplex virus infection generally affects children between ______ Years old
2 to 5
What is primary herpes simplex virus infection associated with?
Fever, headache, malaise, dysphagia, cervical lymphadenopathy
Describe primary heroes simplex virus infection
Short lasting vesicle effective tongue. Lips, buccal, palatial, ginigival mucosa then forming ulceration
What causes reactivation of primary varicella zoster infection ( shingles)
Immunocompromisation or other acute infection
Examples of iatrogenic cause of oral ulcers
Chemotherapy, radiotherapy, graft versus host disease, drug induced ulceration ( potassium channel blockers, bisphosphonates.NSAIDs, DMARDs
Symptoms of neoplastic ulceration
Exophytic, rolled borders, raised, hard to touch, non moveable, not always painful, sensory disturbance
Local management of oral ulceration
Mouthwashes:
Simple
Antiseptic - CHX,hydrogen peroxide, doxycycline
LOCAL ANESTHETIC
-Benzydamine
Steroid- betamethasone
Steroid inhaler: beclomethasone
Onward referral
