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BDS4 > introduction to oral medicine > Flashcards

introduction to oral medicine Flashcards

1
Q

Why might a patch be white? (3)

A
  • Abnormal or increased keratin
  • Increased epithelial thickness
  • Candida
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2
Q

What is this?

A

Pseudomembranous candiasis

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3
Q

4 risk factors for oral candida infection?

A
  • Immunocompromised patient
  • Dentures
  • Smoking
  • Inhaler use
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4
Q

What 3 medications can be used to treat oral candidiasis?

A
  • Fluconazole
  • Miconazole
  • Nyastatin
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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
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6
Q

What is this?

A

Traumatic keratosis

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7
Q

What might cause traumatic keratosis?

A

Trauma leading to increased keratin deposition

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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
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9
Q

Describe appearance of lichen planus?

A

Reticular

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10
Q

Describe appearance of lichen planus?

A

Atrophic

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11
Q

Describe appearance of lichen planus?

A

Papular

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12
Q

Describe appearance of lichen planus?

A

Erosive

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13
Q

Describe appearance of lichen planus?

A

Plaque like

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14
Q

Describe appearance of lichen planus?

A

Bullous

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15
Q

What is oral lichen planus

A

A chronic inflammatory condition leading to destruction of basal keratinocytes by CD8+ T Cells

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16
Q

Which cells are responsible for destruction of basal keratinocytes in lichen planus?

A

CD8+ T cells

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17
Q

If oral lichen planus is symptomatic , how would you describe the pain?

A

burning or stinging

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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
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19
Q

What is the malignant potential of lichen planus over 10 years?

A

1%

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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
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21
Q

What 4 drugs may cause Oral lichenoid reactions?

A
  • Antihypertensives
  • Antimalarials
  • NSAIDs
  • Lithium
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22
Q

What 3 materials may cause OLR?

A
  • Gold
  • Nickel
  • Amalgam
  • Composite resin
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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
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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)
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25
Q

A patient presents with symptomatic lichen planus/OLR , What else would you other than changing restorations, providing advice and medication for symptomatic relief?

A
  • Refer for biopsy
  • inform risk of cancer
  • Investigate and manage cause
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26
Q

What is this?

A

Hairy leukoplakia which is a non removable white patch most commonly affecting the lateral borders of the tongue

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27
Q

What 2 viruses are commonly associated with hairy leukoplakia?

A
  • EBV
  • HIV
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28
Q

What group of patients are more prone to hairy leukoplakia?

A

immunocompromised patients

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29
Q

When might a red patch malignancy rate increase?

A

If there is no clear cause

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30
Q

What is this?

A

Erythmatous candidiasis

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31
Q

What is this?

A

Desquamative gingivitis

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32
Q

What is this?

A

Granulomatosis with polyangitis caused by systemic vasculitis

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33
Q

What is used to manage granulomatosis with polyangitis?

A

immunosuppressants

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34
Q

What 4 symptoms associated with granulomatosis with polyangitis?

A
  • fever
  • weight loss
  • ear, nose or throat manifestations
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35
Q

How would you describe this patch colour?

A

Erythroplakia , red and velvety

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36
Q

What to do if a patient presents with erthroplakia?

A

Refer urgently as high malignancy rate

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37
Q

What is this?

A

Oro-facial granulomatosis disease

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38
Q

What disease is clinically very similar of OFG?

A

Oral Crohn’s

39
Q

What type of patch is this?

A

Erythroleukoplakia

40
Q

How would you manage a patient presenting with erythroplakia?

A

Refer urgently as high risk

41
Q

When examining a white or red patch , what would you assess?

A
  • location
  • colour
  • homogenety
  • hard or soft (induration)
  • Raised or flat
  • Texture
  • wipeability
  • Symmetry
42
Q

Define oral ulceration?

A

A localised defect where there is destruction of epithelium exposing underlying connective tissue

43
Q

4 general causes of ulceration?

A
  • Traumatic
  • Nutritional deficiencies
  • Allergies
  • Infections
44
Q

What 8 things you can ask the patient about to identify the cause of an ulcer?

A
  • Site
  • Onset
  • Duration
  • Number
  • Size
  • Appearance
  • Symptoms
  • Relieving and exacerbating factors
45
Q

What about an ulcer makes you suspect its caused by trauma?

A

Keratotic borders

46
Q

How might an apthous ulcer be different from a traumatic ulcer?

A

It have a red border

47
Q

What can trigger apthous ulcers?

A
  • Stress
  • Trauma
  • Allergy
  • Sensitivity reactions
48
Q

What are 3 catagories of recurrent apthous stomatitis?

A
  • 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
Q

What 2 conditions might be associated with apthous ulceration?

A
  • GI pathologies
  • Anaemia
50
Q

What 4 blood tests can be used to investigate anaemia?

A
  • FBC
  • U&E
  • Liver function test
  • Vitamin B12 test
51
Q

What Behcet’s disease?

A

A chronic inflammatory disease than can present in the mouth with apthous ulceration appearance and affect multiple membranes

52
Q

What 2 other mucous membranes can behget’s disease affect?

A
  • Genitals and eyes
53
Q

Gastrointestinal pathology is associated with oral ulcers, what could you ask the patient to enquire into any GI symptoms? 3

A
  • Any abdominal pain?
  • Any altered bowel motion
  • Any unintentional weight loss?
54
Q

What 4 things to ask a patient about relating to connective tissue disease for enquiry?

A
  • Any rashes ?
  • Any joint pain and stiffness?
  • Any fatigue?
55
Q

What is this?

A

Herpes simplex virus primary infection

56
Q

What 4 symptoms are associated with herpes simplex virus?

A
  • fever
  • lympahdenopathy
  • Headaches
  • Dysphagia
57
Q

What is this?

A

Varicella Zoster virus infection (shingles?)

58
Q

What is the primary form of infection of varicella zoster virus?

A

chicken pox

59
Q

What is the secondary infection of varicella zoster virus after activation of the virus from the sensory ganglion?

A

Shingles

60
Q

What may cause reactivation of varicella zoster virus?

A
  • immunocompromisation
  • other acute infections
61
Q

How would you manage a patient presenting with varicella zoster virus?

A
  • Provide analgesia
  • Difflam mouthwash
  • Liaise with patient GP
62
Q

What 4 drugs may induce ulceration?

A
  • Potassium channel blockers
  • Bisphosphonates
  • NSAIDS
  • DMARDs
63
Q

List 3 iatrogenic causes of oral ulceration?

A
  • Chemotherapy
  • Radiotherapy
  • Graft versus host disease
  • Drug induced
64
Q

What 4 features of an ulcer would make it at higher risk for oral cancer?

A
  • Exophytic
  • Rolled borders
  • Raised
  • Hard to touch
  • fixed in place
65
Q

What are 3 types of pain in general relating to origin?

A
  • nociceptive - putting hand on hot pan
  • inflammatory - irreversible pulpitis
  • pathological - oral dysaesthesia
66
Q

What is one of the cardinal features of inflammatory pain?

A

Dolor

67
Q

What further investigation would you carry out regarding pain after excluding dental cause?

A
  • Blood test
  • Cranial nerve exam
  • MRI
68
Q

What are 2 symptoms associated with oral dysaesthesia?

A
  • Dry mouth feeling
  • Burning sensation
69
Q

What site is common to be affected by oral dysaesthesia?

A
  • the tongue
70
Q

What two things are important to exclude when diagnosing TMD?

A
  • Closed lock and dislocation
71
Q

What is this?

A

Fordyce spots

72
Q

What are fordyce spots?

A

Sebaceous glands

73
Q

What most two common sites in the mouth for fordyce spots?

A

Buccal muscosa or lips

74
Q

What is this?

A

Linea alba , a horizontal asymptomatic white lesion along the occlusal plane

75
Q

3 histological features of linea alba?

A
  • Hyperkeratosis
  • Acanthosis
  • Prominent or reduced granular layer
76
Q

What is this?

A

Geographic tongue : loss of filiform papilla
Also known as migratory glossitis or erythema migrans

77
Q

What might be the symptoms of geographic tongue?

A

Asymptomatic but can sometimes be sensitive to hot and spicy food and toothpaste

78
Q

How would you manage geographic tongue?

A

Advice on using SLS free toothpaste and avoid trigger foods

79
Q

What is this?

A

Fissured tongue - variation of normal anatomy

80
Q

With what is fissured tongue accompanied?

A

Geographic tongue

81
Q

What advice would you give a patient with a fissured tongue?

A

Consider lightly brushing the tongue

82
Q

What is this?

A

Black hairy tongue (asymptomatic)

83
Q

What is black hairy tongue?

A
  • Hyperplasia of filiform papilla
  • build up of commensal bacteria and food debris
  • Pigment inducing fungi and bacteria
84
Q

What 4 causes may be associated with black hairy tongue?

A
  • Smoking
  • Antibiotics
  • Chlorhexidine MW
  • Poor oral hygiene
85
Q

What advice would you give a patient with black hairy tongue?

A
  • Stop smoking
  • Stay hydrated
  • Lightly brush the tongue
  • Eat fresh pineapple
86
Q

What is this?

A

Desquamative gingivitis - full thickness of gingiva erythema

87
Q

What is this?

A

Bony exostosis

88
Q

Where can bony exostosis be present?

A
  • Palate - torus palatinus
  • Mandible - torus mandibularis
  • buccal alveolus
89
Q

What may be the consequences of bony exostosis?

A
  • Can interfere with denture placement
  • May be more prone to ulceration
90
Q

What syndromes can bony exostosis be associated with ?

A

polyposis syndromes such as Gardner’s syndrome

91
Q

What to do to monitor bony exostosis?

A
  • Photos
  • Study models
  • X-rays
92
Q

What is this?

A

Increased melanin pigment

93
Q

If this is not normal melanin pigment , Give 3 differential diagnosis?

A
  • Addison’s disease
  • Smoker’s melanosis
  • Drug related pigmentation

BDS4 (63 decks)

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