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OM > OLP and OLTR > Flashcards

OLP and OLTR Flashcards

1
Q

What is OLP?

A

A common chronic immune-mediated mucocutaneous disease

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2
Q

OLP sites?

A

Oral mucosa
Skin (Nails and scalp)
Ano-genital mucosa

Occasionally:
Pharynx
Esophagus
Conjunctiva

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3
Q

Malignant transformation risk of OLP and OLRT?

A

1% risk over 10 years

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4
Q

Genetic association of OLP

A

HLA (Human Leukocyte Antigen)
Genome Wide Association Studies (GWAS) on chromosome 6

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5
Q

OLP Environmental triggers

A

Restorative materials
SLS
Stress
Trauma
Medical conditions
Medications

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6
Q

Immune system associated with OLP

A

CD8+ T Cells
CD4+ T Cells
Local inflammatory response

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7
Q

OLP Pathogenesis

A
  1. CD8+T Cell mediated destruction of Basal keratinocytes
  2. T Cell activated by antigen presenting cells, expressing MHC 1
  3. T Cells recognize antigen on MHC 1 of basal keratinocytes
  4. Upon recognition of antigen, release of GRANZYME and PERFORIN that disrupt cell membrane leading to death
  5. Also release of TNF- Alpha and IL-6 (pro inflammatory cytokynes) which influence CD4+ T Cells.
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8
Q

RF for OLP

A

Stress
Genetics
GvHD
Diabetes
A.I.D
SLS toothpaste
Dental material

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9
Q

E/O Manifestations to look out for?

A

Skin/Scalp/Nail
Genitals
Eyes
Oesophagus

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10
Q

Sites in mouth affected by OLP?

A

Tongue
Buccal mucosa
Gingiva
Unususal (Palate/ FOM)

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11
Q

Clinical features of OLP?

A

White patch
Red patch
Erosion/ Ulcer

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12
Q

Types of OLP

A

Reticular (asymptomatic)
Atrophic
Erosive
Papular
Plaque like
Bullous

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13
Q

Atrophic OLP

A

Red mucosa
Due to thinning of mucous membrane
Desquamative gingivitis

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14
Q

Erosive OLP

A

Parital loss of epithelium
High risk of malignant change
Irregular pattern
Lower threshold for biopsy
Persistent ulcer

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15
Q

Bullous OLP

A

May be caused by superficial mucoceles
Need to exclude blistering disease

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16
Q

OLP Vs. OLTR Sites

A

OLP is bilateral/ symmetrical
OLTR is unilateral/ near restoration
Buccal mucosa 80%
Tongue 65%
Lips 20%
Palate/ FOM <10%

17
Q

Management of OLP and OLTR in GDP?

A
  1. Provide relevant info to pt
  2. Symptomatic relief
  3. Take clinical photos
  4. Consider referral
  5. PMPR & OHI for desquamative gingivitis
  6. Consider changing restorations
  7. SLS free toothpaste
18
Q

Reasons for referral to OM?

A

Symptomatic
Unilateral/ non-symmetrical
Non-reticular OLP
Unclear diagnosis
Pt has other RF
Biopsy indicated

19
Q

Symptomatic relief for OLP/OLTR

A

Benzydamine 0.15% MW
15ml every 30mins as required

20
Q

What to give if Difflam doesn’t work?

A

Betamethasone 500mcg
Dissolve 1 tablet in 10ml water
Rinse for 5 mins
Spit after rinse
DONT SWALLOW
Up to 4x daily

21
Q

If Difflam doesn’t work and HIGHLY LOCALISED?

A

Clenil Modulite Beclometasone 50mcg MDI
1-2 puffs
Unlicensed
(may be associated with fungal infection)

22
Q

Hydrocortisone Oromucosal tablet dosage?

A

2.5mg
1 tablet dissolved next to lesion 4x daily until healed

23
Q

Triggers to avoid?

A

SLS toothpaste
Avoid trigger foods

24
Q

What to include in referral?

A
  1. Detailed hx
  2. Clinical findings
  3. Provisional diganosis
  4. Why to be seen my specialist
  5. Tx tried
  6. Clinical photos
  7. Refer to OM/OMFS
25
Q

Secondary care management of OLP?

A
  1. Same as primary care
  2. Consider biopsy
  3. If erosive consider FBC, Haematinics, Oral rinse (to exclude fungal infection), skin antibody test
  4. Manage symptoms
  5. Patch testing, stop medications
26
Q

Types of Biopsy?

A

Incisional biopsy for H&E Staining
Incisional biopsy for DI
Incisional punch or Free hand ellipse

27
Q

Histological features of OLP/ OLTR?

A
  1. Death of basal keratinocyte
  2. Colloid bodies/ Civatte bodies
  3. Band like lymphocytic infiltrate (CD8+ T Cell)
  4. Acanthosis
  5. Hyperparakeratosis / Hyperorthokeratosis
  6. Saw tooth rete pegs
  7. Epithelial atrophy or erosion
28
Q

Common drugs asssociated with OLP?

A

ACE inhibitors (ramipril)
Beta-blockers (propanolol)
DMARD (hydroxychloroquine)
Diuretic (Furosemide)
NSAIDs
Hypoglycemics (Metformin)
Biologics ( Infliximab)
Allopurinol

29
Q

Other types of tx for OLP/ OLTR in secondary care?

A
  1. Topical steroids
  2. Systemic steroids ( Prednisolone)
  3. Clobetasol/ Fluocinolone (with vacuum splint)
  4. Tacrolimus ointment
  5. Hydroxychloroquine
  6. Azathioprine
  7. Mycophenolate mofetil
30
Q

How to check patient for Lupus?

A

Anti-nuclear antibodies
Biopsy
Anti-Smith
Anti-dsDNA
Complement
Immunoglobulins and protein eletrophoresis

31
Q

E/O OLP

A

Wickham’s striae ( white areas over skin lesions

32
Q

Malignant chaNge in OLP/ OLTR?

A

1% over 10 years
More common on erosive lesions and tongue
Gradual changes

33
Q

How to look out for malignant change?

A

Increase severity
New lesions
New onset ulcers
Exophytic lesions
Erythema
Dysphagia
Lymphadenopathy

OM (8 decks)

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