Oral Dan Flashcards
Fordyce spots on the vermillion or buccal mucosa are an unusual anatomical variant
False
common - seen in up to 80%
also found on outer labia and shaft of penis or scrotum other free sebaceous glands are;
Tyson’s glands on the foreskin or labia minora
Meibomian glands around the eye
Montgomery’s tubercles of the areola
Geographic tongue occurs in 10% of people
False
1-3%
Geographic tongue is more common in women
False
M=F
Geographic tongue is always confined to the tongue
False
Rarely - can affect buccal mucosa/labial mucosa/soft palate
Geographic tongue has well demarcated erythematous patches with thin scalloped white borders on the lateral and dorsal tongue
True
Geographic tongue (benign migratory glossitis) is a type of psoriasiform mucositis of unknown aetiology which 5x more comon in psoriatics then the general population
True
Geographic tongue does not occur with fissured (scrotal) tongue
False
Can occur together
Geographic tongue is usually asymptomatic
True
but can cause buring or stinging, worse w/ spicy food
Rarely causes burning mouth syndrome
Rx by avoid triggers and potent TCS
Scrotal tongue occurs equally in males and females
True
Scrotal tongue is often associated with geographic tongue
True
But only a few cases of geographic tongue are associated with scrotal tongue
Scrotal tongue occurs in about 15% of adults
True
2-30%
unusual in children
Black hairy tongue is an exceptionally rare condition mainly affecting men
False
is common
affects M=F
Black hairy tongue is due to retention of keratin at tips of filiform papillae on dorsal tongue
True
Black hairy tongue is due to an underlying systemic disease and needs investigation
False
Due to low food intake or soft dietexacerbated by smoking, poor oral hygeine, tetracyclines, hot drinks, oxidizing mouthwashes
Not due to candida or other infection
Black hairy tongue can causeBad breathBad tasteGagging sensation when tongue touches palate
True
Black hairy tongue can be normal in dark skinned individuals
False
dark skinned people may have pigmented papillae presenting a smultiple, unoformly spaced tiny brown papules esp on the lateral surface and tip - not on dorsum like BHT
Treatment of Black hairy tongue involvesfirm regular dietstop smokinggood oral hygeinecan use bicarb mouthwashcan use tongue scraperrefer to dentist or hygeinist
True
Simple glossitis involves loss of filliform papillae with pain and swelling
False
Loss of filiform papillae is atrophic glossitisIn glossitis there is pain, irritation, burning, hypogeusia, dysgeusia
Rx w/ bland soft diet and analgesia
Atrophic glossitis involves inflammation with loss of filliform papillae
True
Median rhomboid glossitis is Well demarcated rhomboid shaped area in midline of posterior dorsal tongue which is erythematous and smooth w/ loss of filiform papillae
True
Median Rhomboid Glossitis afects 1% of adults and children
False
1% of adults but very rare in kids
Median Rhomboid Glossitis is associated with candidiasis, HIV, smoking and wearing dentures
True
Median Rhomboid Glossitis is a congenital defect
False
Median Rhomboid Glossitis is associated with inflammation of the corresponding area of the palate
True
but only in rare cases and should consider HIV or other immunosuppression in these cases
It is necessary to take candidal swabs in all cases of Median Rhomboid Glossitis
True
Candida is number one cause
Improving oral hygeine is sufficient treatment for Median Rhomboid Glossitis
False usually insuffucient swab and treat for candida stop smoking, see dentist, may need new dentures consider HIV or other immunosuppression
White sponge nevus is due to an autosomal dominant muattion in Keratin 3 or 14
False
AD
Keratin 4 or 13
white sponge naevus is noticed at birth or in childhood and affects the buccal mucosa bilaterally
True
Painless shaggy or folded white lesionscan affect resp tract, genitalia, anus
white sponge naevus is premalignant
False
Completely benign
No Rx required
tetracycline swish and spit may help to clear
White oral lesions may be seen in Howel-Evans syndrome
True
The diffuse white oral lesions in Dyskeratosis congenita can resemble leukoplakia or lichen planus clinically and histologically
True
Oral lesions of Dyskeratosis congenita are benign with no malignant potential
False
Can become malignant
Oral mucosal hyperpigmentation is a rare feature of Dyskeratosis congenita
True
Can also get hypocalcified teeth
Oral keratosis is a rare feature of Pachyonychia Congenita
False Occurs in 60% also1 6% natal (neonatal) teeth 10% angular stomatitiscandida common No Rx for keratosis but pts need ongoing dental care
Gingival hyperkeratosis can occur in Unna-Thost variety of PPK
True
Periorificial keratoderma is a feature of Naegeli–Franceschetti–Jadassohn syndrome
False
Characteristic feature of Olmsted’s syndrome
is fissured resembling rhagades
KID syndrome can get dental dysplasia, persistent oral ulcers and mucocutaneous candidiasis
True
Also sometimes get oral carcinoma
In Darier disease oral lesions occur in 50% of those with skin lesions esp if severely affected skin
True
flattish, coalescing red plaques that eventually turn white
affect dorsum of tongue, palate and gingiva
may get salivary duct anomalies
Early loss of teeth is a feature of Papillon Lefevre
True Deciduous teeth usually lost by 5 and permanent teeth by 16 Also Downs diabetes EDS type 8
Materia alba is due to smoking
False
White plaques on gums due to build up of mucosa cells and bacteria if poor oral hygeine
A Cutaneous dental sinus is really a fistula which most commonly arises from the maxillary teeth
False
Is really a fistula but mandibular teeth more commonly then maxillary
A Cutaneous dental sinus arising from the mandibular molars or premolars will most commonly form a discharging skin lesion on the chin or submental region
False
Most common sites of skin lesions are;
Maxillary incisors and canines - cheek
Maxillary molars and premolars – inner canthus, nose, nasolabial fold, upper lip
Mandibular incisors and cuspids – chin or submental region
Mandibular molars and canines – posterior mandible or submandibular regions
The main differentials of a Cutaneous dental sinus areneoplasmpyogenic granulomacervicofacial actinomycosis
True
Desquamative gingivitis presents with painful haemorrhagic necrotic gingivae w/ classic ‘punched out’ interdental papillae
False
This is Necrotizing (Ulcerative) Gingivitis
Necrotizing (Ulcerative) Gingivitis is caused by mixed bacterial infection in susceptible hosts w predisposing risk factors
True Immunosuppression malnutrition stress smoking poor oral hygiene
Necrotizing gingivitis occurs in young/middle aged adults and can cause;Generalized oedema, erythema and haemorrhageFever, malaise, lymphadenopathyfoul odournoma (cancrum oris)
True
Swabs are diagnostic in Necrotizing (Ulcerative) Gingivitis
False
Swabs cultures are non specific
Mainly clinical diagnosis
Should still swab and look for underlying causes and predisposing factors
Refer to dentist for debridement, then broad spectrum AB
Chlorhex oral rinses for bact load, warm salt water rinses for comfort
chronic ulcerative stomatitis affects young men
False
Very rare condition mainly seen in older white womenrare in other groups
Chronic ulcerative stomatitis is due to Autoantibodies to DeltaNp63alpha protein on keratinocyte nuclei
True
Detect on mucosal biopsy IMF or ELISA blood
Dental amalgam foreign body tattoos are the most common cause of acquired pigmentation in the oral mucosa
True
Labial melanotic macules occur in 20% of the normal population
False
up to 3% of normal people
The commonest systemic causes of acquired oral pigmentation are Addison’s, Kaposi’s sarcoma and melanoma
True
Intramucosal (intradermal) naevi account for 50% of mucosal naevi
True
Blue naevi account for one third
Amalgam is the only cause of oral lichenoid contact dermatitis
False Cinnamates (cinnamon flavouring) are the orher main cause Full list; Mercury (amalgam) Gold Copper Nickel Cinnamates Musk ambrette Aminoglycoside antibiotics Chemicals for colour photograph developing Methacrylic acid esters used in the car industry
Lichenoid contact stomatitis causes a thicker histological band of lichenoid change than native oral LP
True
Resurfacing of amalgam fillings is an option for amalgam lichenoid contact stomatitis
True
But is it fails need to remove filings and use composite or porcelain fillings
in Recurrent Apthous Stomatitis one third of cases have a family history
True
simple oral ulcers are more comon in young women
False
more common in men in teens and 20s
Simple ulcers are more common than complex ulcers
True
simple ulcers are divided into 3 types;
Minor
Major
Herpetiform
True
Minor (Mikulicz) ulers the most common type of oral ulcers and should be
False
Are most common but should be Heal w/out scar in 1-2wksRecurrence is usual but infrequent
Major (Sutton’s) oral ulcers are 1-3cm diameter, deep and very painful. Heal slowly with scarring
True
Heal in 4 weeks rather than 1-2 for minor ulcerscan be fever/malaise
Herpetiform simple ulcers are caused by HSV
False Very uncommon condition seen more in women 1-2mm ulcers up to 100 resemble HSV but swab negativeulcers heal w/out scarring but are often continuously present
Simple ulcers are found on the dorsal tongue
False
Usually only occur on NON keratinized mucosa (unlike HSV which can affect anywhere) so not seen on dorsal tongue, hard palate or inner gingivaecommon on underside of tongue and can occur on buccal mucosa of cheeks and in sulcus (often linear here)
The folowing makes oral ulcers worse
sodium lauryl sulphate (toothpaste, mouthwash)
smoking
pregnancy
False
get better in pregnancy
worse with other 2
Simple Recurrent Apthous Stomatitis means 1-2 ulcers occuring up to 3 times per year
Complex Recurrent Apthous Stomatitis mean 3 or more oral or genital ulcers occuring almost continuously
True
Complex apthous ulcers are usually large
False
usualy small like simple minor ulcers
MUST investigate for associations
75% of Behcets pts get oral ulcerations
false
99% do
Multiple lesions,
Thalidomide ca be used for recaltritant ulceration in Behcet’s disease
True
Treatment ladder;
Rx of ulcers – tetracyclines, TCS, general measures
Systemic Rx of Behcets;
Topical steroids
NSAIDs
Systemic; colchicine, steroids, AZA, CsA , SSKI
Infliximab
Thalidomide for recalcitrant orogenital ulceration
Aspirin can cause irritant contact stomatitis
True
Also
vit C tabs, battery acid, bleach, phenol, silver nitrate, petrol, rubbing alcohol
Fibroepithelial polyps are the most common oral cavity tumour
True
Fibroepithelial polyps occur in children
False
adults in 30s-50s (4th-6th decade)
twice as common in women
A pregnancy epulis is a Fibroepithelial polyp
False
An epulis is a lesion arising from the gums - usually a fibroepithelial polypA ‘pregnancy epulis’ is a pyogenic granuloma arising from the gums on a b/g of pregnancy gingivitis
Fibroepithelial polyp often occur along the biteline of the buccal mucosa
True
Also on labial mucosa/tongue/gingivae
A fibroepithelial polyp is the same as an oral fibroma
False
fibrous polyps (fibroepithelial polyps) are often referred to as fibromas but are not true fibromas
A true fibroma is rare in the mouthIt is a neoplastic proliferation of fibroblasts
Needs wide, deep, total excision
Intraoral Fibroepithelial polyps are often symptomatic
False
Asymptomatic unless persistently irritated/traumatizedRx surgery
Also rules out ddx of neoplasm
Morsicatio Buccarum means chronic cheek chewing
True
Traumatic ulcers in the mouth can mimic oral SCC
True
Xerostomia is uncomfortable but doesnt have serious consequences
False
saliva important for neutralizing food acids and forming bolus
Need meticulous dental hygeine as increased risk of caries and take care when chewing and swallowing
Nothing can be done for Xerostomia
False
meticulous dental hygeine
Sugarless gum to activate salivary production
Pilocaprine to stimulate residual salivary flow
Cheilitis Glandularis is a rare Inflammatory hyperplasia of lower labial salivary glands
True
Mainly affects men - UV, smoking, chronic irritationGet slight hypertrophy of lower lip with nodular enlargement and lip eversionUsually dysplastic cheilitis of exposed lip
Increased risk of SCCRx w/ vermillionectomy
A Ranula is a mucocele located on the floor of mouth
True
Mucoceles are most common on the upper labial mucosa
False
lower labial mucosa
Mucocele is caused by a disrupted minor salivary gland duct w/ mucous spilling into submucosal tissue
True
Can be Assoc w trauma/oral LP/oral lichenoid GVHD
Any apparent lesion on retromolar area (arising from the mandible behind the last molar tooth) needs bx
True
mucoepidermoid carcinoma often presents there
Mucocoeles resolve spontaneously
True
But may need surgical excision to completely resolve as can cyclically rupture and refill
A mucoecele is a salivary gland tumour
False
Different things
Salivary gland tumour mainly arise from minor salivary glands
False
Minor glands only 15% of all salivary gland tumours
The most common benign alivary gland tumour is a pleomorphic adenoma
True
salivary gland equivalent of chondroid syringoma (benign mixed tumour of the skin)
The most common malignnat salivary gland tumour is adenocarcinoma
False
Mucoepidermoid carcinomaBut benign tumours are more common than malignant
Leukoplakia is most common premalignant condition of oral cavity
True
must bx to assess for degree of dysplasia and SCC
Leukoplakia is assoc w/ alcohol consumption
True
Also Tobacco esp smoking and sanguinaria (bloodroot)
Leukopakia has 1-5% population prevalence and is common in the over 30s esp women
False
All true but more common in men
In leukoplakia, non-homogenous lesions and tongue or floor of mouth lesions have higher risk of malignancy
True
leukoedema is the same as leukoplakia
False
Its grey/white buccal mucosa, fades w/ stretching, normal variant
Erythroplakia is a rare harmless red plaque of the buccal mucosa
False
Rare red plaque which is more dysplastic when biopsied than leukoplakia
90% of erythroplakia are severely dysplastic AK, IEC or SCC
True
Erythroplakia occurs at a younger age than leukoplakia
False
older age group
M=F
Erythroleukpplakia is an intraoral plaque with both white and red areas
True
often highly dysplastic/SCC
Mildly dysplastic leukoplakia can be monitored
True
But mod/severe dysplastic need treatment
leukoplakia has recurrence rate of 30% or more even afte complete clearance
True
adjuvant immiquimod should be used after surgery or cryotherapy or CO2 laser
Oral Hairy Leukoplakia is due to EBV
True
Oral Hairy Leukoplakia is seen in immunocompetent individuals mainly
FalseT
ypicaly assoc w/ HIV
can be other immunocompromised
Only occasionally immunocompetent pts
Oral hairy leukoplakia affects parakeratinized mucosa on lateral surface of tongue because o the localised candida
False
affects this area because keratinocytes here have EBV receptors.
50% of cases of Oral hairy leukoplakia alos have candida
True
The pathology of oral Hairy Leukoplakia shows hyperparakeratosis, hyperplasia and ballooning of prickle cells and a dense inflammatory infiltarte
False hyperparakeratosis hyperplasia ballooning of prickle cells Only sparse inflammatory infiltrate
Oral leukoplakia is caused by HPV
False
Causal link hasnt been proven although types 6, 11, 16 and 18 have been associated with leukoplakia
Proliferative Verrucous Leukoplakia is a rapidly progressive variant of oral leukoplakia
False
Often present for decades but when it eventually transforms into SCC or verucous cancer is is refractory to treatment
15% alive and disease free @ 12yrs
Proliferative Verrucous Leukoplakia has the same risk factors as common oral leukoplakia
False
women not men
not assoc w/ ETOH, smoking or HPV
Nicotine Stomatitis is the appearance of a grey-white mucosa w/ umbilicated papules w/ central red puncta due to the action of nicotine on the mucosa
False
description correct but due to heat not nicotine
seen in pipe smokers
90% of mouth/oropharynx cancers are SCC
True
SCCs commonly occur on the upper lip vermillion
False
SCC on Lower lip vermillion
BCC more common on upper lip
Oral SCC is associated with smoking, alcohol,betal nut chewing (india), HPV infection (16/18), HSV, poor dentition and immunosuppression
True
Diet rich in fruit/veg is protective against oral SCC
True
Oral SCC most commonly occurs on the dorsal tongue and buccal mucosa
False
Lip most common - 30%
25% on tongue esp lateral and ventral tonguefloor of mouth
Oral SCC can present as an ulcer, an exophytic mass or an endophytic process w/ induration
True
Beware and bx anything lasting >3wks!
EGFR inhibitors increasingly used for head and neck SCC
True
often with surgery and/or XRT
Retinoids can help with prevention of recurrence or secondary lesions of oral SCC
True
Following treatment of oral SCC, 90% of recurrences occur within the first 5 years
False
90% in first 2 years
Oral SCC is far more aggressive than SCC of skin and diagnosed later
True
In oral SCC, 5yr survival rate for stage III/IV disease is 10%
False 5yr survival rates III/IV = 30% 5yr survival rates I/II disease = 80%
After an oral SCC there is a 2-3% annual risk of developing second primary SCC in same region
True
Oral verrucous carcinoma is an uncommon variant of SCC mainly seen in men >50
True
Oral verrucous carcinoma is low grade and slow growing
True
Oral verrucous carcinoma is a white, exophytic warty tumour which often ulcerates
Falser
arely ulcerates
The diagnosis of verrucous carcinoma is easily made on histopathology?
False
Shows
hyperkeratosis w/ ancathotic well differentiated epithelium w papillary/verrucous surface
Dense chronic inflamm infiltrate
Minimal atypia and rare mitotic figures
Must examine multiple sections as 25% show foci of typical SCC
Foci of typical SCC can be found in 25% of verrucous carcinomas
True
Vaerrucous carcinoma can be terated with XRT
False
treat with wide local excisionXRT can increase risk of transformation to anaplastic SCCCan use adjunctive immiquimod/oral retinoids (etretinate)
Oral kaposis sarcoma most often affects the palate
True
hard/soft palatethen gingiva
then dorsal tongue
then anywhere else in oral cavity
Oral akposi sarcoma will often regress with HAART
True
Oral kaposi sarcoma can be terated with XRT
True
Also laser and intralesional vinblastine
Oral melanoma accounts for
True
oral melanoma affects women more than men
False
M>F
oral melanoma is usually in horizontal growth phase at time of diagnosis
False
usually in vertical growth phase
unclear if due to minimal radial phase or just late diagnosis
Oral melanoma is more common on the upper gums than the lower
True
But hard palate most common site
Oral melanomas may be amelanotic and present as erythroplakia or a lesion resembling pyogenic granuloma or SCC
True
Oral melanoma has 5yr survival=5%, median survival of 2yrs
False
5 year survival is 15%
median survival of 2yrs
Hodgkins disease can arise in the oral cavity
False
Non hodgkins lymphoma can
head and neck is second most common site after GIT
seen more in HIV pts
soft/rubbery-firm slow growing mucosa-coloured or purplish swelling
May ulcerate or have surface telys
A fixed drug eruption can present as recurrent oral apthae
True
Drug-induced gingival hyperplasia starts after several years on the drug
False
Enlargement during 1st year of drug administration
Drug-induced gingival hyperplasia is most frequently associated with ciclosporin
False Phenytoin most often phenytoin (50%), nifedipine (25%), CsA (25%)
Drug Related Gingival Hyperplasia starts at the interdental papillae of the anterior teeth on the labial (external) side
True
Poor oral hygeine incerases susceptibilty to Drug Related Gingival Hyperplasia
True
Causes of gingival hyperplasia include lithium, bactrim, pregnnacy and scurvy
True
Also leukaemia, sarcoidosis, Amyloidosis, Wegeners, kaposis, Crohns, Acromegally
Also erythromycin phenytoin and other anticonvulsants, nifedipine and other Ca channel blockers and CsA
Recombinant human keratinocyte growth factor (palifermin) reduces severity of mucositis. Used in pts given high dose chemo and XRT for HSCT
True
Mucositis usually occurs in the first week of radiotherapy
False
3rd week
Mucositis occurs in pts who receive chometherapy induicng neutropenia
True
Ulcers occur 4-7 days after administration of chemo
Pts with cyclic neutropenia get crops of oral apthae coinciding with nadir of neutropenia
True
Venous lakes can only be treated with lasers
False LN2 cryo (closed clold probe technique) hyfrecation (fine needle diathermy) infrared coagulation LASER - Nd:YAG best, can use PDL w/ stacked pulses IPL excision
Melkersson-Rosenthal syndrome is a triad ofgranulomatous cheilitisfacial palsy or ptosis andscrotal tongue
True
although not all cases have all 3 features
The full triad of Melkersson-Rosenthal syndrome occurs in 50% of cases
False
only 25% of cases
facial nerve palsy in 13-50%
What is orofacial granulomatosis?
Non caseating, non infectious granulomatous inflammation of lips, face or oral cavity
Includes granulomatous cheilitis, Crohn’s, sarcoidosis
(Idiopathic) Granulomatous cheilitis (cheilitis granulomatosis, ‘orofacial granulomatosis’) affects the ower lip more commonly than the upper lip
False
Upper lip more common
(Idiopathic) Granulomatous cheilitis (cheilitis granulomatosis, ‘orofacial granulomatosis’) causes symmetrical sweling
False
assymetrical
(Idiopathic) Granulomatous cheilitis (cheilitis granulomatosis, ‘orofacial granulomatosis’) has a sudden onset
True
(Idiopathic) Granulomatous cheilitis (cheilitis granulomatosis, ‘orofacial granulomatosis’) is thought to be due to an immune complex vasculitis
False
Thought to be to cell-mediated hypersensitivty food/food additives/certain flavourings (esp cinnamate aldehyde)
The causes of a Granulomatous cheilitis includeidiopathic including Melkersson-RosenthalCrohnssarcoidosisallergic contact dermatitis/mucositis
True
Granulomatous cheilitis usually has florid granulomas on histo
False
often sparse
Non caseating, non infectious type
ILCS provide long term cure in idiopathic granuloamtous cheilits (orofacial granulomatosis)
False
can work but tendency to relapse
Other Rx;
dapsone, clofazimine, HCQ, tetracyclines, thalidomide, TNF alpha inhibitors
granuloamtous cheilits affects younga dults mainly and M=F
True
Oral involvement is common in Crohns disease
False
Uncommon - 5-15%
Oral Crohns most often presents as cobblestone elsions of the buccal mucosa
False Linear ulceration of buccal vestibule most common Also can be; granulomatous cheilitis Persistent firm painless swelling of labial/buccal mucosa or facial tissuesoral apthae cobblestone lesions pysostomatitis vegetans fibrosis and adhesions
Oral Crohns responds to systemic Rx of Crohns but ILCS may be required
True
e.g. steroids, AZA, 6-mercapto, MTX, TNFα inhibitors
Strawberry gums may be seen in Wegener’s granulomatosis
True
petechial haemorrhage superimposed on friable micropapular surface
Pathognomonic
Wegener’s granulomatosis can affect the naspharynx causing epistaxis, sinusitis, nasal obstruction and saddle nose deformity
True
Wegener’s granulomatosis affecting the oral mucosa and skin is usually part of a superficial mucocutaneus form of the disease w/out systemic involvement
False
Superficial form exists but more often it is a presentation of systemic disease - need full investigation
Gingival pain and bleeding are uncommon in oral Wegener’s
False
these are common complaints
Macroglossia affects up to 5% of pts with primary systemic amyloidosis
False
20%
Amyloidosis can cause haemorrhagic papules/plaques of tongue or other oral mucosal sites
True
can also cause;
macroglossia with or w/out ulcerationtaste disturbance / dysguesia
xerostomia from salivary gland involvement
Pernicious anaemia is 20x more likely in those with an affected close relative
True
most common cause of B12 def
affects 2% of population over 60 esp women
Pyostomatitis Vegetans commonly affects the dorsum of the tongue
False
dorsum usually spared
affcets lips, gums and buccal mucosa mainly
Pyostomatitis Vegetans is associated with UC more than Crohn’s disease
True
The typical appearance of pyostomatitis vegentans is multiple ‘snail track’ linear arrays of pustules and small erosions on diffuse mucosal erythema
True
Pyostomatitis Vegetans affects man and women equally
false
Men more oftenage range 20-60 usually
Important differentials for pyostomatitis vegetans include HSV, apthae, syphylis and oral pemphigus vulgaris
True herpetiform simple apthae HSV oral pemphigus vulgaris/vegetans candida secondary syphylis (also snail track lesions)
Oral LP is up to 8x more common than cutaneous LP
True
Oral LP can cause loss of filiform papillae on the tongue
True
Chronic erosive or atrophic oral LP carries a 5% risk of SCC over 10 yrs
True
need close follow up
Histopath of oral LP is identical to skin LP
False
similar but saw-tooth rete ridges are rare
Typical LS occurs in the oral mucosa
False
can get LP/LS overlap
Histo similar to LP but; epithelial atrophy, hyperkeratosis, oedema of the papillary corium and lymphocytic infiltrate is not as close to the epithelium as in LP
Oral lesions are common in IgA pemphigus
True
all types
Oral lesions ocur in 50% of SLE pts
True
oral lesions in SLE are typically red patches that break down leaving slit like ulcers
True
can also get oral petechiae
DLE lesions can occur on oral mucosa
True
Oral HSV is unusual in SLE pts
False
common
Angular stomatitis is a common feature of chronic mucocutaneous candidiasis
True
Primary herpetic stomatitis usually due to HSV1
True
10% of cases of HSV stomattis become chronic
False
One third do
herpes labialis (cold sores) are due to recurrence of oral HSV
True
Primary disease causes herpes stomatitis or rarely herpetic geometric glossitis
Incubation period for oral primary HSV is 3-7 days
True
Herpetic geometric glossitis causes a painless deep longitudinal groove and shallower lateral fissures
False
appearance is correct but very painful
VZV stomatitis can cause gingivitis but primary oral HSV stomatitis does not
False
Other way around
Zoster of the maxillary branch of CNV affects hard palate, upper gingiva and buccal sulcus unilaterally
True
a few lesions may cross the midline
Zoster of the mandibular branch of CNV affects the hard palate, lateral tongue, and lower labial and buccal mucosa
False
affects floor of mouth, lateral tongue, and lower labial and buccal mucosamaxillary branch zoster affects hard palate
Herpangina is a syndrome of fever, sore throat, cluster of 2-4mm vesicles turning into ulcers at back of throat/tonsils or soft palate
True
Herpangina is caused by HSV2
False coxsackie viruses (mainly A can be B)
Hand, foot and mouth disease is caused by coxsackie A
True
coxsackie A, sometimes B and enteroviruses
Hand, foot and mouth disease is worse in childhood
False
Adults become sicker but self limiting usually
Encephalitis is a frequent complication of hand, foot and mouth disease
False
very rare
CMV can cause persistant oral ulceration in HIV pts
True
EBV (glandular fever) presenting with severe sore throat is called anginose type EBV
Truecan cause laryngeal obstruction
All types of syphylis can affect the oral region
True
Primary - chancre
secondary - split papule perleche, mucous patches (30%), small oral ulcers, syphylitic sore throat
Tertiery - leukoplakia, gummata
Congenital - rhagades, Hutchinsons teeth, oral ulcers (rare)
A gumma of the tongue or palate is the most common presentation of tertiery syphylis in the mouth
False
Gumma is the characteristic lesion but premalignant leukoplakia is most common
A swab for spirochetes is reliable in the diagnosis of oral syphylis
False
spirochetes are normally found in the mouthclean surface with sterile gauze then scrape with spatula
Mucous patches of the buccal mucosa are seen in 60% of cases of secondary syphylis
False
30%
Oral hairy leukoplakia has fine white hairs growing out of it
False
No hairs just a white corrugated appearance
a dorsal tongue ulcer is the most common presentation of oral TB
True
Minor (simple) recurrent apthus ulcers account for half of all caes
False 80% of apthus ulcers Types of simple apthus ulcers are Minor Major Herpetiform
Complex oral apthosis is defined as;Almost constant presence of at least 3 (oral/genital) – In the absence of Behcet’s disease
True
Simple apthous ulcers are cremy white with an erythematous halo
True
turn grey when healingmajor ulcers may have oedema
herpetiform are more punched out
simple apthous ulcers usually number les than 6 with attacks up to 3 times per year
True
simple apthous ulcer disease can be exacerbated by stress, cessation of smoking, immunodeficiency and the menstural cycle
True
Depression and anxiety are common causes of burning mouth syndrome
True
30-70%
