Oral disease

Question 1

Oral ulceration?

Answer 1

Discontinuity in oral mucosa

Question 2

Solitary ulcer?

Answer 2

Trauma (physical or chemical)
Malignancy (oral squamous cell carcinoma)
Infective (TB, tertiary syphilic)

Question 3

Multiple ulcers?

most common cause

Answer 3

RAU (recurrent aphthous ulceration)
Usually well - no systemic disease
Exclude iron deficiency & GI disease
Major, minor, herpetiform

Question 4

Minor aphthous ulcers?

Answer 4

Most common
<10mm
Heal within 14 days, no scarring
Rarely affect dorsum tongue or hard palate

Question 5

Major aphthous ulcers?

Answer 5

> 10 mm
Weeks/ months
Heal with scarring

Question 6

Bechets?

Answer 6

Multisystem condition
Hereditary systemic vasculitis (inflammation of blood vessels)
Almost identical ulcers to RAU
+ Genetic ulceration, uveitis, erythema nodosum

Question 7

Anaemia?

Answer 7

Mucosal pallor
Oral ulceration
Glossitis (inflammation of tongue)
Angular chellitis
Predisposition to candida
Disturbed taste

Question 8

Other causes of multiple ulcers?

Answer 8

Mucocutaenous disorders

• Lichen Planus
• Lupus erythematous
• Vesiculobullos disease (pemphigus and pemphigoid)

Question 9

Lupus erythematosus?

Answer 9

Discoid or systemic (AI)
Ulceration
White patches, red and white
Similar appearance to lichen P

Question 10

Vesiculobullos disease - pemphigus vulgaris?

Answer 10

Oral manifestations 1st
Painful, extensive oral ulcers
Preceded by blisters
Nikolsky sign

Question 11

Vesiculobullos disease - pemphigoid?

Answer 11

Autoimmune
Blisters
Painful oral ulceration
Affects mucous membranes of other organs e.g. eyes

Question 12

What are oral manifestations of GI disease due to?

Answer 12

Underlying malabsorption & consequent haematinic deficiency

Question 13

Gi diseases with oral manifestations?

Answer 13

Crohn’s
UC
Peutz jeghers
Gardners syndrome

Question 14

Oral manifestations of Crohn’s?

Answer 14

May precede abdominal symptoms
Cobble-stone mucosa
Localised mucogingivitis
Linear ulceration
Tissue tags/ polyps
Diffuse swelling (lips)
Pyostomatitis vegetans

Question 15

Pyostomatitis vegetans?

Answer 15

Erythema and oedema of the mucosa and numerous small, superficial yellow pustules

Question 16

Oral manifestations of UC?

Answer 16

Oral ulceration
Pyostomatitis vegetans
Angular stomatitis
Reflects UC severity

Question 17

White patches that can be wiped off?

Answer 17

Usually pseudomembranous candidiasis/ thrush

Question 18

Candidiasis?

Answer 18

Fungal infection due to any type of candida (yeast type)

Question 19

White patches that can’t be wiped off?

Answer 19

Trauma
Epithelial dysplasia
Neoplasia
Chronic mucocutaneous candidiasis

Question 20

Lichenoid inflammation (white patches)

Answer 20

Chronic inflammation along base of epithelium in band like distribution with some damage to keratinocytes in basal layer of epithelium

Question 21

Trauma causing white patches?

Answer 21

White mucosa as epithelium produced keratin in response as protective mechanism

Question 22

Causes of trauma?

Answer 22

Cheek chewing
Jagged edges of teeth
Ill-fitting dentures

Question 23

Leukoplasia?

Answer 23

Persistent white patches
SMOKING & alcohol
Pre-malignant
Biopsy & histology

Question 24

Transient white patches?

Answer 24

Candida infection

Systemic lupus erythematosus

Question 25

When is oral candidiasis seen?

Answer 25

After broad spectrum antibiotics Inhaled steroids Diabetes, seriously ill, immunocompromised

Question 26

Oral pigmentation?

Answer 26

``` Racial Melanotic macules (lip freckle) Malignancy Smoking Addison’s disease ```

Question 27

Addisons disease?

Answer 27

Excess ACTH/MSH released from pituitary in response to reduced cortisol levels

Question 28

Xerostomia?

Answer 28

Dry mouth SE of drugs, radiation therapy Can be due to Sjogren's syndrome

Question 29

Sjogren's syndrome?

Answer 29

Autoimmune disease Dry eyes and mouth Primary or secondary

Question 30

Oral manifestations of Sjogren's syndrome?

Answer 30

Enlarged salivary glands | Dry mouth causing caries (decay), depapillated tonugue, red, dry wrinkley mucosa

Question 31

Dental erosion?

Answer 31

Loss of surface of teeth due to acid

Question 32

Leukemia?

Answer 32

``` Gingival enlargement Petechiae (tiny, purple/red spots) Mucosal bleeding Ulceration Boggy gingivae ```

Question 33

Lymphoma?

Answer 33

Palpable lymph nodes Diffuse swelling (extra/ intramural) Ulceration Tooth migration/ mobility

Question 34

Oral manifestations of HIV?

Answer 34

``` Ulceration Kaposi's sarcoma HPV lesions Salivary gland swelling As result of immunosuppression Inc malignancy risk ```

Question 35

Kaposi's sarcoma?

Answer 35

Type of cancer that can form masses in the skin, lymph nodes, or other organs. Usually purple

Question 36

Are red or white patches more concerning?

Answer 36

Red

Question 37

Common high risk sites?

Answer 37

Lateral borders of tongue Ventral tongue surface Floor of mouth

Question 38

Biggest risk factors for oral disease?

Answer 38

Smoking & drinking

Question 39

Where do HPV associated cancers commonly occur?

Answer 39

Tonsils

Question 40

Pre-malignant lesions?

Answer 40

Leucoplakia (white) Lichen Plans Submucous fibrosis Ertythroplakia (red)