Intro to Oral Med Flashcards
What are the functions of saliva?
- Acid buffering
- Mucosal lubrication (speech, swallowing)
- Taste facilitation
- Antibacterial
- Digestive
What are the causes of xerostomia (dry mouth)?
- Salivary gland disease
- Age, smoking, alcohol
- Medication
- Medical conditions (diabetes, stroke etc) & dehydration (renal)
- Radiotherapy
- Anxiety/ somatisation disorders
What diseases/ conditions can directly cause salivary gland disease?
- Aplasia (e.g. ectodermal dysplasia)
- HIV (lympho-epithelial cysts, focal lymphocytic sialadenitis- focal collection of lymphocytes)
- Gland infiltrations (e.g. sarcoidosis- granulomas, amyloidosis- protein, haemochromatosis- iron)
- Cystic fibrosis (autosomal recessive inheritance)- ALL exocrine glands affected
What are some medications that can induce xerostomia (dry mouth)?
- Anti-depressants = amitriptyline- tricyclic, citalopram- SSRI
- Antipsychotics
- Antihistamines
- Anticonvulsants = carbamazepine, gabapentin
- Diuretics (dehydration)
Which chronic medical problems cause dry mouth?
- Diabetes (insipidus & mellitus)
- Renal disease
- Stroke (medications)
- Addison’s disease
- Persistent vomiting
Which acute conditions cause dry mouth?
- Vesicullobullous diseases
- Shock (haemorrhage, burns)
What is primary Sjogren’s syndrome?
Just gland problems, not CT disease
What is secondary Sjogren’s syndrome?
Gland problems with CT disease (e.g. SLE, RA, scleroderma)
Name a criteria used to diagnose Sjogren’s?
Modified American-European Criteria
What are the criteria for the MAEC of Sjogren’s?
- Subjective dry eyes (“gravel in eyes”)
- Objective dry eyes (Schirmer test <5mm in 5 mins)
- Subjective dry mouth (>3 months, Shallacom scale)
- Objective dry mouth (<1.5ml in 15mins)
- Auto-antibody findings (anti-Ro/La)
- Histopathological findings (+ve labial gland biopsy)
Describe a classic appearance of Sjogren’s seen on a sialography
- ‘Leopard-spots appearance’
- ‘Snow-storm appearance’
==> appearance of punctate sialectasis
What are the treatment options for dry mouth?
- Identify and treat underlying cause
- -> correct hydration, modify drug regime, control diabetes, somatoform disorders
- Prevent progression of oral disease
- -> caries mamagement, F regime, diet mod
- Saliva substitutes (sprays, lozenges, salivary stimulants, oral car systems)
What are the two categories that hypersalivation can be divided into?
- True (stroke, degenerative disease- CJD, Ms, Alzheimer’s)
- Perceived (swallowing reflex inhibited, anxiety disorders)
What is a mucocele?
- Traumatic lesion to minor salivary gland
- Causing a swelling containing saliva
- Commonly seen in the lower lip
- 2 types = extravasation or retention
What is a ranula?
- Descriptive term for mucocele seen on FOM
- Commonly sublingual extravasation
Which salivary gland is commonly associated with duct obstruction?
- Submandibular
- Occasionally parotid
What is sialosis?
- Non-neoplastic
- Non-inflammatory
- Non-tender
- Salivary gland enlargement
- With NO identifiable cause!!
What is the most commonly seen salivary gland tumour and which glands are they common seen in?
- Pleomorphic adenoma
- Parotid gland
What are the causes for swellings in the salivary glands?
- Secretion retention (mucocele, duct obstruction)
- Gland hyperplasia
- Salivary tumours
- Infection (viral- paramyxovirus, bacterial)
What are the characteristics of dental pain?
- Acute/ subacute
- Gets better or worse!
- Rarely chronic
What is neuropathic pain?
- Chronic pain usually due to trauma to nerve
- Characterised by burning/ aching pain in a fixed location, often same intensity
- Traumas include = extractions, post-herpetic neuralgia
What are the management options for neuropathic pain?
MEDICATION
- Systemic = pregabalin, gabapentin, tricyclic antidepressants
- Topical = capsaicin, EMLA, benzdamine
What is ‘atypical odontalgia’?
- Dental pain without detected pathology
- Not related to tooth but rather psychological manifestation
- Typical pattern = cycle of intermittent periods of pain-free episode followed by intense unbearable pain (lasting 2-3 weeks)
What is ‘trigeminal neuralgia’?
- Chronic facial pain, characterised by severe intense sudden sharp pain upon pressure of trigger point lasting up to a few minutes
- Trigeminal nerve involvement
What are the treatment options for trigeminal neuralgia?
DRUG THERAPY
- Carbamazepine 100mg (1 tablet 2x daily) for 10 days and refer to specialist (if positive response)
SURGICAL INTERVENTION
- Peripheral neurectomies (recovering nerve –> pain will return)
- Trig N Balloon Compresison
- Microvascular Decompression (MVD)
- Radiosurgery (Gamma knife)
What are some forms of vacular facial pain?
- Classic migraine
- Common migraine
- Temporal arteritis
- Cluster headaches
What is a ‘cluster headache’?
- Generalised/ localised intense painful headaches usually during evenings
- May include autonomic (vasomotor) changes = tearing, blocked nose, ‘swelling’ over painful site, pupillary changes
What are the types of oral dysaesthesia?
Dysaesthesia = abnormal sensory PERCEPTION
- Thermal
- Taste
- Touch
- Moistness
Describe ‘thermal dysaesthesia’
- ‘Burning Mouth Syndrome’
- Most likely associated with haematinic def = vit b12, folic acid, ferritin
Describe ‘moisture dysaestheisa’
- ‘Dry mouth’
- Worst at night
- V common
- Most obviously associated with anxiety disorders
Describe ‘taste dysaesthesia’
- ‘Bad taste/ smell’
- NAD by practitioner
- NB ENT causes (chronic sinusitis), perio/dental infecitons
Describe ‘touch dysaesthesia’
- ‘Pins & needles/ tingling’
- Exclude organic neurological diseases (cranial n testing)
- Exclude local causes (tumours, infections)
What is typically seen in a HISTORY of a pt presenting with TMD-related symptoms?
- Periodicity (morning/ evening exacerbation)
- Parafunctional clenching
- Anxious pt
What is typically seen in a EXAMINATION of a pt presenting with TMD-related symptoms?
- Focal muscle tenderness (MoM)
- Tenderness of TMJ itself
- Locking?
- Joint noises? (clicking/ crepitus)
- Trismus?
- Deviation on opening (commonly seen in muscle dysfunctions)
- Occlusal disharmony?
What investigations are carried out for TMD?
Usually NONE
- Ultrasound indicated = need to see functional disc movement
- OPT/ CBCT = bone problem suspected
- MRI = best for image of disc
- Arthroscopy = direct visualisation of disc needed
What is the management for TMD?
- CONSERVATIVE first, includes…
- -> Education = CBT, soft diet, gum chewing advice, analgesia, self-help
- -> Physiotherapy = exercises
- -> Bite splint made
- DRUG THERAPY
- -> Tricyclics (not SSRIs)
- -> Anxiolytic meds
What is the aetiology for oral dysaesthesia?
- ANXIETY
- DEFICIENCIES
- Diabetes melitis
- Xerostomia
- Denture design faults/ allergy
- Parafunction
What are the investigations for oral dysaesthesia?
- Blood test = FBC, ferritin, folate, vit b12 and glucose
- Salivary flow rate = <1.5ml in 15 mins
- Parafunction & denture assessment
- Allergy assessment
- Psychological assessment
What are the management for ora dysaesthesia?
- Reassurance not cancer
- Correct deficiencies/ blood sugar
- Difflam m/w
- Correct parafunction/ denture faults
- CBT
- Antidepressant/ gabepentin therapy
