OLP and mucosal lesions

Question 1

causes of lichen planus

Answer 1

majority idiopathic , can be related to medications or amalgam restorations

Question 2

name 3 medications assosciated with lichen planus

Answer 2

anti hypertensives - ACE inhibitors, beta blockers, diuretics
NSAIDs
DMARDs

Question 3

describe the steps of lichen planus diagnosis

Answer 3

1. remove any cause - medicines, amalgam restorations
2. biopsy - unless good reason not too
3. blood tests - lesions can be more symptomatic in patients with haematinic deficiencies
4. auto antibody screen if lupus is suspected

Question 4

treatment of mild intermittent lichen planus lesions

Answer 4

topical OTC remedies e.g CHX mouthwash or benzydamine mouthwash
Avoid SLS containing toothpaste

Question 5

what topical steroids may be used for treating persisting symptomatic Lichen planus lesions

Answer 5

beclomethasone MDI - 50mcg puff , 2 puffs, 2-3 times/ day
betamathasone rinse - 500mcg in 10ml water, 2 min rinse 4x / day

Question 6

what disease does graft versus host look like

Answer 6

lichen planus

Question 7

if palatal lichen planus lesions are found what disease must always be considered

Answer 7

lupus erythematosis

Question 8

how does lupus differ from lichen planus histologically

Answer 8

lymphocytic infiltrate is much deeper than the basement membrane

Question 9

why do steroid inhalers increase candida risk

Answer 9

steroids reduce inflammation and therefore the bodies ability to remove pathological candida

Question 10

what is aciclovir and what is it used to treat

Answer 10

anti-viral medication
used to treat herpetic gingivostomatitis, recurrent herpetic lesions and shingles (recurrent herpes zoster)

Question 11

name 3 non steroidal topical treatment options for an oral mucosal lesion

Answer 11

chlorhexidine mouthwash
benzydamine mouthwash/ spray - topical anaesthetic
bonjela

Question 12

instructions for use of betamethasone mouthwash

Answer 12

mix 500mcg tablet with 10ml water, rinse for 2 mins QDS
Do not swallow and avoid eating and drinking for 30 mins after use

Question 13

instructions for patient using beclomethasone MDI for oral mucosal lesions

Answer 13

place device exit vent directly over ulcer area, 2 puffs, 2-4x daily
no rinsing after use
must be a pressurised device NOT breath activated

Question 14

name 3 steroid based topical treatments for oral mucosal lesions

Answer 14

hydrocortisone mucoadhesive pellets
betamethasone mouthwash
beclomethasone MDI

Question 15

name 3 risks of systemic steroids

Answer 15

osteoporosis
peptic ulcer
adrenal suppression
sleep alteration

Question 16

what is the lamina propria

Answer 16

lower layer of mucous membranes separated from epithelium by basement membrane
made of loose, fibrous connective tissue and contains fibroblasts, lymph nodules and notably lacks adipocytes

Question 17

in healthy mucosa, what is the only layer cell division should occur

Answer 17

basal layer only

Question 18

acanthosis

Answer 18

thickening of epithelium as a reactive change usually due to trauma or immunological damage

Question 19

atrophy

Answer 19

thinning
reduction in viable layers

Question 20

erosion

Answer 20

partial thickness loss

Question 21

intracellular vs intercellular oedema

Answer 21

intra - within cells, all slightly larger due to fluid
inter - between cells, known as spongiosis

Question 22

immune cause of geographic tongue

Answer 22

alteration to maturation and replacement of normal epithelial surface
whole areas of epithelial surface are replaces on a single occasion.
cells are lost without replacement cells being made resulting in thinning of the epithelial layer - red patches

Question 23

black hairy tongue

Answer 23

hyperplasia of filliform papillae causing elongation and ‘hairy ‘ appearance
then acquire stain from food, drink, smoke and CHX

Question 24

treatment of black hairy tongue

Answer 24

removal of elongated papillae either with tongue scraper or sucking on peach/nectarine stone for about an hour a day (too large to be inhaled)