Mouth and gum conditions Flashcards
Leukoplakia
White patches in the mouth
Often on the tongue or buccal mucosa
Which cancer can leukoplakia be a precursor for
Squamous cell carcinoma
Features of leukoplakia
Asymptomatic, irregular and slightly raised.
Fixed - cannot be scraped off
Investigations for leukoplakia
Biopsy - exclude dysplasia
Management of leukoplakia
Smoking cessation
Reducing alcohol intake
Close monitoring
Potentially laser removal or surgical excision.
Erythroplakia
Red patches in the mouth
Erythroleukoplakia
Lesions that are a mixture of red and white
Which cancer is erythroplakia associated with
Squamous cell carcinoma
Management of erythroplakia
Refer urgently to exclude cancer
Lichen Planus
Autoimmune condition that causes localised chronic inflammation of the skin
Presentation of lichen planus
The skin has shiny, purplish, flat-topped raised areas with white lines across the surface called Wickham’s striae
Can also affect the mouth
Who normally gets lichen planus
Over 45 yo
Women
Patterns of lichen planus in the mouth
Reticular
Erosive
Plaque
Reticular lichen planus
Net-like web of white lines called Wickham’s striae
Erosive lichen planus
Surface layer of the mucosa is eroded, leaving bright red and sore areas of mucosa
Plaque lichen planus
Larger continuous areas of white mucosa
Management of lichen planus
Good oral hygiene
Smoking cessation
Topical steroids
Gingivitis
Inflammation of the gums
Presentation of gingivitis
Swollen gums
Bleeding after brushing
Painful gums
Bad breath (halitosis)
Complication of gingivitis
Periodontitis
Periodontitis
Severe and chronic inflammation of the gums and the tissues that support the teeth.
This often leads to loss of teeth
Acute necrotising ulcerative gingivitis
Rapid onset of severe inflammation in the gums.
Painful
What causes acute necrotising ulcerative gingivitis
Anaerobic bacteria
Risk factors for gingivitis
Plaque build-up on the teeth (inadequate brushing)
Smoking
Diabetes
Malnutrition
Stress
Tartar
Hardened plaque
Management of gingivitis
Managed by dentist
Good oral hygiene
Smoking cessation
Remove plaque and tartar
Chlorhexidine mouth wash
Antibiotics for acute necrotising ulcerative gingivitis (e.g., metronidazole)
Dental surgery if required
Causes of gingival hyperplasia
Gingivitis
Pregnancy
Vitamin C deficiency (scurvy)
Acute myeloid leukaemia
Medications
Which medications can cause gingival hyperplasia
- CCBs
- phenytoin
- ciclosporin
Aphthous Ulcers
Very common
Small, painful ulcers of the mucosa in the mouth
Appearance of aphthous ulcers
Well-circumscribed, punched-out, white appearance
Triggers for aphthous ulcers
Emotional or physical stress
Trauma to the mucosa
Particular foods
Conditions associated with aphthous ulcers
Inflammatory bowel disease
Coeliac disease
Behçet disease
Vitamin deficiency (iron, B12, folate and vitamin D)
HIV
How long do aphthous ulcers take to heal
Usually within 2 weeks
Management of aphthous ulcers
Normally self resolve
If persist:
- Choline salicylate (e.g. Bonjela)
- Benzydamine (e.g., Difflam spray)
- Lidocaine
Management of severe ulcers
Topical corticosteroids
Hydrocortisone buccal tablets applied to the lesion
Betamethasone soluble tablets applied to the lesion
Beclomethasone inhaler sprayed directly onto the lesion
2 week wait referral for mouth lesion
Unexplained ulceration lasting over 3 weeks
