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Oral Medicine > Intro to Oral Med > Flashcards

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
Q

What are the treatment options for trigeminal neuralgia?

A

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
Q

What are some forms of vacular facial pain?

A
  • Classic migraine
  • Common migraine
  • Temporal arteritis
  • Cluster headaches
27
Q

What is a ‘cluster headache’?

A
  • Generalised/ localised intense painful headaches usually during evenings
  • May include autonomic (vasomotor) changes = tearing, blocked nose, ‘swelling’ over painful site, pupillary changes
28
Q

What are the types of oral dysaesthesia?

A

Dysaesthesia = abnormal sensory PERCEPTION

  1. Thermal
  2. Taste
  3. Touch
  4. Moistness
29
Q

Describe ‘thermal dysaesthesia’

A
  • ‘Burning Mouth Syndrome’

- Most likely associated with haematinic def = vit b12, folic acid, ferritin

30
Q

Describe ‘moisture dysaestheisa’

A
  • ‘Dry mouth’
  • Worst at night
  • V common
  • Most obviously associated with anxiety disorders
31
Q

Describe ‘taste dysaesthesia’

A
  • ‘Bad taste/ smell’
  • NAD by practitioner
  • NB ENT causes (chronic sinusitis), perio/dental infecitons
32
Q

Describe ‘touch dysaesthesia’

A
  • ‘Pins & needles/ tingling’
  • Exclude organic neurological diseases (cranial n testing)
  • Exclude local causes (tumours, infections)
33
Q

What is typically seen in a HISTORY of a pt presenting with TMD-related symptoms?

A
  • Periodicity (morning/ evening exacerbation)
  • Parafunctional clenching
  • Anxious pt
34
Q

What is typically seen in a EXAMINATION of a pt presenting with TMD-related symptoms?

A
  • 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
Q

What investigations are carried out for TMD?

A

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
Q

What is the management for TMD?

A
  • 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
Q

What is the aetiology for oral dysaesthesia?

A
  • ANXIETY
  • DEFICIENCIES
  • Diabetes melitis
  • Xerostomia
  • Denture design faults/ allergy
  • Parafunction
38
Q

What are the investigations for oral dysaesthesia?

A
  • 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
Q

What are the management for ora dysaesthesia?

A
  • Reassurance not cancer
  • Correct deficiencies/ blood sugar
  • Difflam m/w
  • Correct parafunction/ denture faults
  • CBT
  • Antidepressant/ gabepentin therapy

Oral Medicine (13 decks)

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