introduction to oral medicine Flashcards
1
Q
Why might a patch be white? (3)
A
- Abnormal or increased keratin
- Increased epithelial thickness
- Candida
2
Q
What is this?
A
Pseudomembranous candiasis
3
Q
4 risk factors for oral candida infection?
A
- Immunocompromised patient
- Dentures
- Smoking
- Inhaler use
4
Q
What 3 medications can be used to treat oral candidiasis?
A
- Fluconazole
- Miconazole
- Nyastatin
5
Q
How else can you manage candidiasis?
A
- in smokers - smoking cessation
- inhaler use - rinse after use and use spacer
- denture wearer - denture hygiene
6
Q
What is this?
A
Traumatic keratosis
7
Q
What might cause traumatic keratosis?
A
Trauma leading to increased keratin deposition
8
Q
What are the 6 types of oral lichen planus and oral lichenoid reactions relating to appearance?
A
- Reticular
- Atrophic
- Papular
- Erosive
- Plaque like
- Bullous
9
Q
Describe appearance of lichen planus?
A
Reticular
10
Q
Describe appearance of lichen planus?
A
Atrophic
11
Q
Describe appearance of lichen planus?
A
Papular
12
Q
Describe appearance of lichen planus?
A
Erosive
13
Q
Describe appearance of lichen planus?
A
Plaque like
14
Q
Describe appearance of lichen planus?
A
Bullous
15
Q
What is oral lichen planus
A
A chronic inflammatory condition leading to destruction of basal keratinocytes by CD8+ T Cells
16
Q
Which cells are responsible for destruction of basal keratinocytes in lichen planus?
A
CD8+ T cells
17
Q
If oral lichen planus is symptomatic , how would you describe the pain?
A
burning or stinging
18
Q
What is the difference between Oral lichen planus and Oral lichenoid tissue reaction?
A
- Oral lichen planus is generalised and idiopathic
- Oral lichenoid tissue reaction is localised and may be a response to medicines or allergens
19
Q
What is the malignant potential of lichen planus over 10 years?
A
1%
20
Q
What 3 things of the patient medical history would you ask for investigating lichen planus?
A
- Lupus
- Graft versus host disease
- recent cancer therapy
21
Q
What 4 drugs may cause Oral lichenoid reactions?
A
- Antihypertensives
- Antimalarials
- NSAIDs
- Lithium
22
Q
What 3 materials may cause OLR?
A
- Gold
- Nickel
- Amalgam
- Composite resin
23
Q
A patient presents with symptomatic lichen planus/OLR , What advice would you give to relieve symptoms?
A
- Avoid trigger factors such as spicy foods and fizzy drinks
- Rinse with HSMW
24
Q
A patient presents with symptomatic lichen planus/OLR , What would you prescribe to relieve symptoms?
A
- Local anaesthetic ( benzydamine, lidocaine)
- Steroid mouthwash ( betamethasone MW , beclomethasone inhaler)
25
A patient presents with symptomatic lichen planus/OLR , What else would you other than changing restorations, providing advice and medication for symptomatic relief?
* Refer for biopsy
* inform risk of cancer
* Investigate and manage cause
26
What is this?
Hairy leukoplakia which is a non removable white patch most commonly affecting the lateral borders of the tongue
27
What 2 viruses are commonly associated with hairy leukoplakia?
* EBV
* HIV
28
What group of patients are more prone to hairy leukoplakia?
immunocompromised patients
29
When might a red patch malignancy rate increase?
If there is no clear cause
30
What is this?
Erythmatous candidiasis
31
What is this?
Desquamative gingivitis
32
What is this?
Granulomatosis with polyangitis caused by systemic vasculitis
33
What is used to manage granulomatosis with polyangitis?
immunosuppressants
34
What 4 symptoms associated with granulomatosis with polyangitis?
* fever
* weight loss
* ear, nose or throat manifestations
35
How would you describe this patch colour?
Erythroplakia , red and velvety
36
What to do if a patient presents with erthroplakia?
Refer urgently as high malignancy rate
37
What is this?
Oro-facial granulomatosis disease
38
What disease is clinically very similar of OFG?
Oral Crohn's
39
What type of patch is this?
Erythroleukoplakia
40
How would you manage a patient presenting with erythroplakia?
Refer urgently as high risk
41
When examining a white or red patch , what would you assess?
* location
* colour
* homogenety
* hard or soft (induration)
* Raised or flat
* Texture
* wipeability
* Symmetry
42
Define oral ulceration?
A localised defect where there is destruction of epithelium exposing underlying connective tissue
43
4 general causes of ulceration?
* Traumatic
* Nutritional deficiencies
* Allergies
* Infections
44
What 8 things you can ask the patient about to identify the cause of an ulcer?
* Site
* Onset
* Duration
* Number
* Size
* Appearance
* Symptoms
* Relieving and exacerbating factors
45
What about an ulcer makes you suspect its caused by trauma?
Keratotic borders
46
How might an apthous ulcer be different from a traumatic ulcer?
It have a red border
47
What can trigger apthous ulcers?
* Stress
* Trauma
* Allergy
* Sensitivity reactions
48
What are 3 catagories of recurrent apthous stomatitis?
* Major - greater than 1 cm and takes long time to heal
* Minor - less than 1 cm and heals within 2-3 weeks
* Herpetiform - multiple small ulcers
49
What 2 conditions might be associated with apthous ulceration?
* GI pathologies
* Anaemia
50
What 4 blood tests can be used to investigate anaemia?
* FBC
* U&E
* Liver function test
* Vitamin B12 test
51
What Behcet's disease?
A chronic inflammatory disease than can present in the mouth with apthous ulceration appearance and affect multiple membranes
52
What 2 other mucous membranes can behget's disease affect?
* Genitals and eyes
53
Gastrointestinal pathology is associated with oral ulcers, what could you ask the patient to enquire into any GI symptoms? 3
* Any abdominal pain?
* Any altered bowel motion
* Any unintentional weight loss?
54
What 4 things to ask a patient about relating to connective tissue disease for enquiry?
* Any rashes ?
* Any joint pain and stiffness?
* Any fatigue?
55
What is this?
Herpes simplex virus primary infection
56
What 4 symptoms are associated with herpes simplex virus?
* fever
* lympahdenopathy
* Headaches
* Dysphagia
57
What is this?
Varicella Zoster virus infection (shingles?)
58
What is the primary form of infection of varicella zoster virus?
chicken pox
59
What is the secondary infection of varicella zoster virus after activation of the virus from the sensory ganglion?
Shingles
60
What may cause reactivation of varicella zoster virus?
* immunocompromisation
* other acute infections
61
How would you manage a patient presenting with varicella zoster virus?
* Provide analgesia
* Difflam mouthwash
* Liaise with patient GP
62
What 4 drugs may induce ulceration?
* Potassium channel blockers
* Bisphosphonates
* NSAIDS
* DMARDs
63
List 3 iatrogenic causes of oral ulceration?
* Chemotherapy
* Radiotherapy
* Graft versus host disease
* Drug induced
64
What 4 features of an ulcer would make it at higher risk for oral cancer?
* Exophytic
* Rolled borders
* Raised
* Hard to touch
* fixed in place
65
What are 3 types of pain in general relating to origin?
* nociceptive - putting hand on hot pan
* inflammatory - irreversible pulpitis
* pathological - oral dysaesthesia
66
What is one of the cardinal features of inflammatory pain?
Dolor
67
What further investigation would you carry out regarding pain after excluding dental cause?
* Blood test
* Cranial nerve exam
* MRI
68
What are 2 symptoms associated with oral dysaesthesia?
* Dry mouth feeling
* Burning sensation
69
What site is common to be affected by oral dysaesthesia?
* the tongue
70
What two things are important to exclude when diagnosing TMD?
* Closed lock and dislocation
71
What is this?
Fordyce spots
72
What are fordyce spots?
Sebaceous glands
73
What most two common sites in the mouth for fordyce spots?
Buccal muscosa or lips
74
What is this?
Linea alba , a horizontal asymptomatic white lesion along the occlusal plane
75
3 histological features of linea alba?
* Hyperkeratosis
* Acanthosis
* Prominent or reduced granular layer
76
What is this?
Geographic tongue : loss of filiform papilla
Also known as migratory glossitis or erythema migrans
77
What might be the symptoms of geographic tongue?
Asymptomatic but can sometimes be sensitive to hot and spicy food and toothpaste
78
How would you manage geographic tongue?
Advice on using SLS free toothpaste and avoid trigger foods
79
What is this?
Fissured tongue - variation of normal anatomy
80
With what is fissured tongue accompanied?
Geographic tongue
81
What advice would you give a patient with a fissured tongue?
Consider lightly brushing the tongue
82
What is this?
Black hairy tongue (asymptomatic)
83
What is black hairy tongue?
* Hyperplasia of filiform papilla
* build up of commensal bacteria and food debris
* Pigment inducing fungi and bacteria
84
What 4 causes may be associated with black hairy tongue?
* Smoking
* Antibiotics
* Chlorhexidine MW
* Poor oral hygiene
85
What advice would you give a patient with black hairy tongue?
* Stop smoking
* Stay hydrated
* Lightly brush the tongue
* Eat fresh pineapple
86
What is this?
Desquamative gingivitis - full thickness of gingiva erythema
87
What is this?
Bony exostosis
88
Where can bony exostosis be present?
* Palate - torus palatinus
* Mandible - torus mandibularis
* buccal alveolus
89
What may be the consequences of bony exostosis?
* Can interfere with denture placement
* May be more prone to ulceration
90
What syndromes can bony exostosis be associated with ?
polyposis syndromes such as Gardner's syndrome
91
What to do to monitor bony exostosis?
* Photos
* Study models
* X-rays
92
What is this?
Increased melanin pigment
93
If this is not normal melanin pigment , Give 3 differential diagnosis?
* Addison's disease
* Smoker's melanosis
* Drug related pigmentation
