LESIONS Flashcards
What are 3 indications of antibiotic px?
- elevated temperature
- evidence of systemic spread
- local lymph involvement
What are 3 potential treatment options for a peri-apical abscess?
- extraction
- endo
and/or - incision of the swelling
What is the aetiology of a periodontal abscess?
occlusion/trauma or opening of gingival pocket
What is the treatment for periodontal abscess?
xla if recurrent
otherwise, sub ging scaling and irrigate pockets
consider abx if pyrexia or cellulitis
What is the aetiology of a periapical abscess?
infection around the apex of a tooth associated with tooth decay or trauma causing necrosis of the pulp and thus, infection causing pain and potential swelling
What is the aetiology for ANUG?
- smoking
- poor OH
- stress
- compromised immunity
What is the treatment for ANUG?
- oral debridement
- abx (metronidazole)
- OHI
- smoking cessation
What are 5 clinical features of ANUG?
- soreness/bleeding
- crater like ulcers
- lateral spread of ulceration
- halitosis
- malaise
What is the following defining?
- inflammation of soft tissues associated with the crown of a partially erupted tooth
pericoronitis
What are 5 clinical features of pericoronitis?
- pain
- swelling
- trismus
- halitosis
- abscess
What is the treatment for pericoronitis?
- remove debris
- OHI
- abx?
- xla
Which viral infection is the following?
triggers: fever, sunlight, common cold, stress, malnutrition
prodronal phase: tingling prior to appearance
heals in 7-10 days
infectious until crusting complete
tx: aciclovir
herpes simplex virus
Which viral infection is the following?
features: oral vesicles that ulcerate, oedema, erythema, coated tongue/halitosis
affects children and young adults
secondary infection may occur - bells palsy
recovery 10-14 days
tx: food/fluid, analgesics, CH mw, aciclovir
primary hepatic stomatitis (gingivostomatitis)
Which viral infection is the following?
itchy rash mainly affecting face and trunk
other features include: oral ulceration, fever, malaise, irritability, enlarged lymph
varicella - primary
Which viral infection is the following?
pain is a constant feature, patients can sometimes not distinguish between trigeminal zoster and toothache
complications: post herpetic neuralgia
tx: aciclovir
zoster - secondary
What are 9 predisposing factors to fungal infections?
- physiological: age, pregnancy
- trauma: ill fitting dentures
- dietary: high carb intake
- endocrine: addisons, diabetes
- malignany: leukaemia
- immune defect: AIDs
- xerostomia: drug/radiation induced
- disturbed oral flora: antibiotics/steroids
- other factors: hospitalisation, smoking
Which fungal infection is the following?
- presents with marked soreness and erythema, particularly on the palate and dorsum of the tongue, the filiform papillae disappear, and the dorsal surface of the tongue appears smooth
- it is usually asymptomatic or is accompanied by a mild burning and itching sensation
- usually secondary to broad spectrum abx
- may be a feature of HIV
- painful
acute erythematous oral candidiasis
Which fungal infection is the following?
- can manifest in nodular form or as white plaques on the cheek or tongue, that are not easily removed
- it presents with mild symptoms, but has an associated increased risk of malignancy
- most common in men over 30 and in smokers
chronic hyperplastic candidiasis
Which fungal infection is the following?
- affects any surface
- can be wiped away, asymptomatic
- common in patients taking abx, steroids, immune defects
- tx: anti fungals and testing for HIV/malignancy
pseudomembranous candidosis (thrush)
Which oral manifestation is the following?
- associated with atopic conditions, and psoriasis, characterised by central erythema caused by atrophy of the filiform papillae and surrounding slightly elevated, white-yellow borders
geographic tongue
Which oral manifestation is the following?
- accumulation of excess keratin on the filiform papillae of the dorsal surface of the tongue, leading to the formation of elongated strands that look like hair
- the colour of the tongue an range from white or tan to black, it occurs most commonly in smokers, those with poor OH, and those who overuse MWs
hairy tongue
Which oral manifestation is the following?
- a white patch or plaque on the mucosa that cannot be rubbed off, may be caused by chronic exposure to irritants or chronic infection
- commonly a benign condition, but may be pre-malignant
leukoplakia
Which oral manifestation is the following?
- an inflammatory condition with two main types
lichen planus
Which type of lichen planus is the following?
- characterised by bilateral, asymptomatic, white, lacy striations (or papules) on the posterior buccal mucosa
- this form is easily identifiable and does not usually require further investigation
reticular lichen planus
Which type of lichen planus is the following?
- manifests as zones of tender erythema and painful ulcers surrounded by white, radiating striae and may require biopsy to rule out serious cases
erosive lichen planus
Which oral manifestation is the following?
- early lesions are often asymptomatic, appear as areas of red or white patches, and may be ulcerated or exophytic (growing outwards)
squamous cell carcinoma
Which oral manifestation is the following?
- lesions are usually macular, but may be nodular or pedunculated
- pigmentation varies from dark brown, to blue-black, however mucosa coloured or white patches may be seen and erythema is observed when lesions are inflamed
malignant melanoma
What are 7 oral manifestation seen in pregnancy?
- perio
- caries
- pregnancy gingivitis
- pregnancy epulis
- candidosis
- gingival hyperplasia
- tooth mobility
Which fungal infection is caused by dentures/ortho appliances?
candida-associated denture induced stomatitis
Which fungal infection affects the dorsal surface of the tongue with predisposing factors such as denture wearers, diabetes, smoking, candidal infections?
median rhomboid glossitis
Which oral lesion is the following?
- widespread erythema, ulceration and soreness
- often develops in patients on chemo or radiotherapy
- treatment is to relieve pain, speed healing and prevent sepsis
- topical analgesic gels, good OH, antifungal, antiviral prophylaxis
mucositis
Which 5 conditions can be a risk factor for erosive red oral lesions?
- lichen planus
- pemphigus vulgaris
- benign mucous membrane pemphigoid
- erythema multiforme
- behcets syndrome
Which lesion is the following?
- defined as any lesion of the oral mucosa that presents as a bright red velvety plaque which cannot be characterised clinically or pathologically as any other recognisable condition
erythroplakia
Which oral lesion is the following?
- less common than leukoplakia but increased risk of malignant transformation
- mainly seen in elderly males
- red, velvety pastches commonly on soft palate, FOM or buccal mucosa
- tobacco, alcohol and malnutrition known risk factors
- treatment includes removal of causal factors and biopsy
erythroplakia
Which oral lesion is the following?
- may be seen as a combination of or transition between leukoplakia and erythroplakia
- consists of white flecks or fine nodules on an atrophic erythematous base
speckled leukoplakia
Which oral lesion is the following?
- the presence of erythema, ulceration, erosion, blistering or desquamation of the attached and marginal gingivae
desquamative gingivitis
Which oral lesion is the following?
aetiology:
- platelet deficiency
- drugs: aspirin
- HIV
- glandular fever
- vomiting in bulimia
clinically:
- red or brown pinpoint lesions (petechiae) or eccymoses mainly at sites of trauma
treatment:
- treat the underlying cause, full blood count
purpura
Which oral lesion is the following?
- dilated lingual veins
- middle aged and elderly age appears to be an important risk factor
- no treatment required unless to confirm diagnosis
lingual varices
Which oral lesion is the following?
- affect infants/children mostly
- red or blue painless lesions
- usually affects the tongue/lip, blanch on pressure
- usually grow initially and stabilise
- majority of lesions are symtomless and require no treatment - observe and refer if persists
haemangioma
Which oral lesion is the following?
- frequently associated with HIV infection
- HAART may slow down the development of AIDs and AIDs related lesion
- refer
kaposis sarcoma
Which oral lesion is the following?
- elongation of the filiform papillae in conjunction with pigment-producing bacteria
more common with:
- soft diet
- smoking/betel nut chewers
- dry mouth
- poor OH
- fasting
- drug abusers
black hairy tongue
Which oral lesion is the following?
- occasionally amalgam following apicectomy
- graphite from a pencil
- asymptomatic
amalgam tattoo
Which oral lesion is the following?
- relatively common benign lesions
- usually flat singular brown collections of melanin containing cells
- vermillion border of lip and palate
- best removed to exclude melanoma
idiopathic melanotic macules
Which oral lesion is the following?
- less common - like a mole found in the oral cavity
- blue-black benign lesion of melanocytes
- palate and elsewhere in the mouth
- asymptomatic
- best removed to exclude melanoma
melanotic naevus
Which oral lesion is the following?
- highly malignant but rare compared with skin lesions
- unknown aetiology
clinically:
- heavily pigmented macule affecting the palate or maxillary gingivae
- rapid increase in size, change in colour, ulceration, pain
- refer!
malignant melanoma
Which oral lesion is the following?
- most common cause of oral pigmentation
- mainly in BAME groups but is noted in some fair skinned people
- brown pigmentation affecting the gingiva
racial pigmentation
Which syndrome is the following?
aetiology:
- genetic, rare
clinically:
- GI polyps
- melanotic macules on lips and oral mucosa
- refer for cancer screening because of high risk of GI, pancreatic and breast cancers
peutz-jeghers syndrome
Which 5 extrinsic factors can cause brown/blue/black oral lesions?
- tobacco: smokers melanosis
- anti malarials
- oral contraceptives
- anticonvulsants
- minocycline
Which condition is the following?
aetiology:
- bluish-black plaque affecting the buccal mucosa, gums, palate and tongue
- diffuse intraoral pigmentation or melanotic patches on the tongue, gingiva, buccal mucosa and hard palate
- extra oral pigmentation on the body commonly seen in creases, folds and near scars
- brown pigmentation of gingiva
addisons disease
When describing a lesion, what does sessile mean?
broad based
When describing a lesion, what does pedunculated mean?
has a ‘stalk’
When describing a lesion, what does macule mean?
flat, <1cm
When describing a lesion, what does patch mean?
flat, >1cm
When describing a lesion, what does papule mean?
circumscribed, solid elevation of skin <1cm
When documenting the history of a lesion, what 9 things should be assessed?
- size of the lesion
- colour of the lesion
- any chances in size, shape or colour
- fixed or mobile
- effect of the lesion
- ill or well defined margins
- duration of the lesion
- shape of the lesion
- where does it originate from (location)
What are variations of normal anatomy?
- fordyce spots
- fissured tongue
- varicosities
Which oral lesion is the following?
- classic features are multiple circular or semicircular pink or red areas on the top of the tongue, with the red areas partially surrounded by a slightly raised yellow-white rim or border
geographic tongue
Which oral lesion is the following?
- is a common condition that appears as a white slightly raised keratotic line along the occlusal plane of the buccal mucosa
linea alba
What is the term for chronic cheek biting lesion?
morsicatio buccarum
Which oral lesion is the following?
- benign vascular lesions appear as red or purple areas on the oral mucosa are usually seen in older patients
haemangioma
What are 4 oral manifestations of coeliac disease?
- glossitis
- angular cheilitis
- RAS (recurrent apthous ulcers)
- enamel hypoplasia
What are 8 oral manifestations of crohns disease?
- swelling of lip and face
- cobblestoning
- ulcers
- angular cheilitis
- lip fissures
- perioral erythema
- persistent lymphadenopathy
- full width gingivitis
What are 2 oral manifestaions of ulcerative colitis?
- apthous ulcers
- angular cheilitis
What are 4 oral manifestations of GORD?
- enamel erosion
- toothwear from antacids
- caries from antacids
- barretts oesophagus
What are 6 oral manifestations of hepatic disease?
- intra oral jaundice
- petechiae
- purpura
- ecchymoses
- excessive gingival bleeding
- prolonged bleeding
What are 6 oral manifestations of aenemia?
- pallor of oral mucosa
- glossitis
- oral candidosis
- angular cheilitis
- dysphagia
- oesophageal web
What are 6 oral manifestaions of acute leukaemia?
- ginigval swelling
- ulcers
- petechiae
- purpura
- candida infections
- swelling with leukaemic cells
What are 2 inherited bleeding disorders?
- haemophilia a & b
- von willebrands disease
What are 2 acquired bleeding disorders?
- liver disease
- vitamin k deficiency
What are 3 oral manifestations of SLE (systemic lupus erythematous)?
- non specific or lichenoid lesions
- purpura
- ulcers
- may respond to corticosteroids
What are 2 oral manifestations of rheumatoid arthritis?
- limted opening, crepitus, stiffness and pain of the TMJ
- xerostomia (sjogrens syndrome)
What are 3 oral manifestations of sjogrens syndrome?
- parchment-like mucosa
- lobulated, depapillated tongue
- xerstomia
What are 4 oral manifestations of scleroderma?
- mouth opening is restricted ‘fish mouth’
- dysphagia (difficulty swallowing)
- widening of the PDL
- trismus secondary to tightness of skin
(OH difficult to maintain due to deformity of hands)
Which disease has the oral manifestation of a painful ulcer centre of the tongue but any region of the oral mucosa may be involved?
tuberculosis
Which oral manifestation is the following?
- bilateral white striations, papules or plaques on buccal mucosa, tongue, gingiva, lips
- reticular most common
- erosive is most symptomatic
lichen planus
What are 2 oral manifestations of pemphigus vulgaris and pemphigoid?
- blistering in the mouth
- desquamative gingivitis
What are the 3 main causes of desquamative gingivitis?
- mucous membrane pemphigoid
- lichen planus
- pemphigus vulgaris
What are 4 symptoms of desquamative gingivitis?
- erythema
- desquamation
- erosion
- blistering of attached and marginal gingiva
What are 2 oral manifestations of psoriasis?
- psoriasis may manifest on the lips, tongue, palate, buccal mucosa and gingiva
- geographic tongue
What are 10 oral manifestations of diabetes?
- xerostomia
- susceptible to periodontal disease
- oral candidosis
- burning mouth syndrome
- lichenoid drug reactions
- swelling of salivary glands
- poor wound healing
- altered taste
- oral paraesthesia
- susceptibility to caries
- sweet smelling breath
What are oral manifestations of hormonal disturbances? (pregnancy, puberty, menopause)
- generalised fibrous hyperplasia of marginal gingiva
- erythema
- tendency to bleed
- not painful
What are the 4 types of epulis?
- pregnancy
- fibrous
- carcinomatous
- giant cell
What are 6 manifestations of addisons disease?
- oral pigmentation
- macroglossia
- facial pain
- mandibular growth
- malocclusion
- hypercementosis
What are 3 fungal lesions seen in HIV?
- pseudomembranous candidiasis
- erythematous candidiasis
- angular cheilitis
What are 4 viral lesions in HIV?
- oral hairy leukoplakia
- varicella-zoster
- herpes simplex
- HPV
- ulcers (pus oozing from surface)
What are 3 bacterial lesions seen in HIV?
- HIV associated gingivtis and periodontitis
- linear gingival erythema
- ANUG
What are 2 neoplastic lesions seen in HIV?
- kaposis sarcoma
- lymphoma
What are 3 ‘other’ oral manifestations seen in HIV?
- purpura
- swelling of salivary glands
- xerostomia
increased incidence of xerotomia due to HAART
What are the 4 types of ulcers?
- apthous
- recurrent apthous
- major apthous
- herpetiform (coalesce into ulcerated patches)
