Intro to Oral Med Flashcards

1
Q

What are the functions of saliva?

A
  1. Acid buffering
  2. Mucosal lubrication (speech, swallowing)
  3. Taste facilitation
  4. Antibacterial
  5. Digestive
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2
Q

What are the causes of xerostomia (dry mouth)?

A
  • Salivary gland disease
  • Age, smoking, alcohol
  • Medication
  • Medical conditions (diabetes, stroke etc) & dehydration (renal)
  • Radiotherapy
  • Anxiety/ somatisation disorders
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3
Q

What diseases/ conditions can directly cause salivary gland disease?

A
  • 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
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4
Q

What are some medications that can induce xerostomia (dry mouth)?

A
  • Anti-depressants = amitriptyline- tricyclic, citalopram- SSRI
  • Antipsychotics
  • Antihistamines
  • Anticonvulsants = carbamazepine, gabapentin
  • Diuretics (dehydration)
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5
Q

Which chronic medical problems cause dry mouth?

A
  • Diabetes (insipidus & mellitus)
  • Renal disease
  • Stroke (medications)
  • Addison’s disease
  • Persistent vomiting
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6
Q

Which acute conditions cause dry mouth?

A
  • Vesicullobullous diseases

- Shock (haemorrhage, burns)

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7
Q

What is primary Sjogren’s syndrome?

A

Just gland problems, not CT disease

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8
Q

What is secondary Sjogren’s syndrome?

A

Gland problems with CT disease (e.g. SLE, RA, scleroderma)

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9
Q

Name a criteria used to diagnose Sjogren’s?

A

Modified American-European Criteria

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10
Q

What are the criteria for the MAEC of Sjogren’s?

A
  1. Subjective dry eyes (“gravel in eyes”)
  2. Objective dry eyes (Schirmer test <5mm in 5 mins)
  3. Subjective dry mouth (>3 months, Shallacom scale)
  4. Objective dry mouth (<1.5ml in 15mins)
  5. Auto-antibody findings (anti-Ro/La)
  6. Histopathological findings (+ve labial gland biopsy)
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11
Q

Describe a classic appearance of Sjogren’s seen on a sialography

A
  • ‘Leopard-spots appearance’
  • ‘Snow-storm appearance’

==> appearance of punctate sialectasis

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12
Q

What are the treatment options for dry mouth?

A
  • 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)
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13
Q

What are the two categories that hypersalivation can be divided into?

A
  • True (stroke, degenerative disease- CJD, Ms, Alzheimer’s)

- Perceived (swallowing reflex inhibited, anxiety disorders)

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14
Q

What is a mucocele?

A
  • Traumatic lesion to minor salivary gland
  • Causing a swelling containing saliva
  • Commonly seen in the lower lip
  • 2 types = extravasation or retention
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15
Q

What is a ranula?

A
  • Descriptive term for mucocele seen on FOM

- Commonly sublingual extravasation

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16
Q

Which salivary gland is commonly associated with duct obstruction?

A
  • Submandibular

- Occasionally parotid

17
Q

What is sialosis?

A
  • Non-neoplastic
  • Non-inflammatory
  • Non-tender
  • Salivary gland enlargement
  • With NO identifiable cause!!
18
Q

What is the most commonly seen salivary gland tumour and which glands are they common seen in?

A
  • Pleomorphic adenoma

- Parotid gland

19
Q

What are the causes for swellings in the salivary glands?

A
  • Secretion retention (mucocele, duct obstruction)
  • Gland hyperplasia
  • Salivary tumours
  • Infection (viral- paramyxovirus, bacterial)
20
Q

What are the characteristics of dental pain?

A
  • Acute/ subacute
  • Gets better or worse!
  • Rarely chronic
21
Q

What is neuropathic pain?

A
  • 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
22
Q

What are the management options for neuropathic pain?

A

MEDICATION

  • Systemic = pregabalin, gabapentin, tricyclic antidepressants
  • Topical = capsaicin, EMLA, benzdamine
23
Q

What is ‘atypical odontalgia’?

A
  • 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)
24
Q

What is ‘trigeminal neuralgia’?

A
  • Chronic facial pain, characterised by severe intense sudden sharp pain upon pressure of trigger point lasting up to a few minutes
  • Trigeminal nerve involvement
25
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)
26
What are some forms of vacular facial pain?
- Classic migraine - Common migraine - Temporal arteritis - Cluster headaches
27
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
28
What are the types of oral dysaesthesia?
Dysaesthesia = abnormal sensory PERCEPTION 1. Thermal 2. Taste 3. Touch 4. Moistness
29
Describe 'thermal dysaesthesia'
- 'Burning Mouth Syndrome' | - Most likely associated with haematinic def = vit b12, folic acid, ferritin
30
Describe 'moisture dysaestheisa'
- 'Dry mouth' - Worst at night - V common - Most obviously associated with anxiety disorders
31
Describe 'taste dysaesthesia'
- 'Bad taste/ smell' - NAD by practitioner - NB ENT causes (chronic sinusitis), perio/dental infecitons
32
Describe 'touch dysaesthesia'
- 'Pins & needles/ tingling' - Exclude organic neurological diseases (cranial n testing) - Exclude local causes (tumours, infections)
33
What is typically seen in a HISTORY of a pt presenting with TMD-related symptoms?
- Periodicity (morning/ evening exacerbation) - Parafunctional clenching - Anxious pt
34
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?
35
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
36
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
37
What is the aetiology for oral dysaesthesia?
- ANXIETY - DEFICIENCIES - Diabetes melitis - Xerostomia - Denture design faults/ allergy - Parafunction
38
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
39
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