oral diseases Flashcards
A 70 year old male patient is diagnosed with T1N0M0 squamous cell carcinoma in the left lateral tongue. He has well-controlled hypertension, raised cholesterol and type 2 diabetes. He has smoked for 50 years and regularly consumes more than 14 units of alcohol per week.
Which factor has the greatest impact on prognosis?
Stage of the disease.
48 year old male who attends C/O pain in his upper centrals. He has noticed his face becoming red and OE you can see blistering/rashes on the hard palate.
What is the most probable diagnosis?
Shingles
19 year old female with RMH including the recent removal of intestinal polyps and strong family history of cancers. She has marked peri-oral pigmentation but IO exam is otherwise normal.
What is the most likely diagnosis?
Peutz-Jegher’s Syndrome
(rare genetic disorder characterised by noncancerous hamartomatous polyps in the digestive tract and pigmented spots on the lips/mouth/fingers).
46 year old male presenting with pain in LR jaw on biting, pointing to LR6. You do a sensibility test which is normal but the tooth is TTP. The radiograph shows bifurcation.
What is the most likely reason for this tooth being TTP?
Bifurcation Lesion
17 year old male presents with bouts of 3-4 ulcers which occur on his tongue and buccal mucosa, healing within 2 weeks.
What type of ulceration is this likely to be?
Minor RAS
50 year old female CO dry mouth and dry eyes for the last 6 months. Her rheumatologist recently completed blood tests which came back positive for the anti-Ro antibody.
Which autoimmune disease is the patient likely to have?
Sjögren’s Syndrome
76 year old male presents with denture stomatitis. RMH includes recent DVT and taking warfarin, denture hygiene is good.
Which of the following is the most appropriate treatment for the condition?
Nystatin Oral Suspension
Sublingual haematoma is found in which fracture?
Mandibular
28 year old male presenting with recurrent bouts of 20+ ulcers under his tongue which are painful and heal within 2 weeks.
What is the most likely diagnosis?
Herpetiform RAS
27 year old male presenting with pain and swelling underneath the right side of his mandible. Symptoms get worse at mealtimes - you manage this acute episode and refer to Oral Surgery.
What would be the most appropriate initial investigation to perform in secondary care?
Mandibular Occlusal Radiograph
(focuses on the mandible and surrounding structures, useful for examining hard to visualise areas)
Base of skull fractures commonly present with:
Raccoon eye bruising.
A 7 year old child has just undergone the XLA of LLE, what post-op analgesic should you recommend?
250mg Paracetamol
What is the most common aetiology for facial fractures in the UK?
Interpersonal Violence
Which medication prescribed for cardiac disease has been reported to cause oral ulceration?
Nicorandil - used to treat angina.
65 year old pt complains of tongue sticking to the roof of mouth with a lobulated appearance.
Which condition are they at a greater risk of developing?
Oral Candidiasis
What is oedema?
Collection of fluid in or between layers of the skin which causes swelling.
What type of patient does ANUG typically occur in?
Smokers and immunocompromised patients.
Clinical features of ANUG?
(think of the name)
- Soreness and bleeding of the gingivae.
- Crater like ulcers due to necrosis of the interdental papillae.
- Halitosis.
Cause of ANUG?
Unknown cause.
Predisposing factors for ANUG
- Poor OH
- Stress
- Smoking
- Depressed Immune Response
3 ways to manage ANUG
- Plaque control (supra PMPR)
- Antibiotics - 400mg Metronidazole every 8 hours for 3 days.
- Smoking cessation.
suspect systemic causes if this does not work
What are 2 things to remember before prescribing metronidazole?
2 warnings not to do whilst on the medication
- No alcohol can be consumed.
(metronidazole blocks alcohol metabolism) - Can’t prescribe if the pt is pregnant.
Which bacterium causes syphilis?
Treponema Pallidum
(gains entry via mucous membranes and skin abrasions).
What are 2 clinical features of primary syphilis?
Primary lesions on any part of the oral mucosa +/- genital lesions.
Cervical lymph node enlargement which is not tender.
3 clinical features of secondary syphilis.
(type of ulcers and lymph nodes)
- Grey-white ulcers covered by thick slough.
- Snail trail ulcers.
- Palpable lymph nodes which are not tender.
What are 4 clinical features of tertiary syphilis?
- Syphilitic leukoplakia.
- ‘Gumma’ chronic granuloma (usually palatal which breaks down to cause a tissue defect).
- Firbosing glossitis.
- Osteomyelitis of the jaw (bacterial infection of the bone)
Which 2 developmental anomalies are found alongside congenital syphilis?
Hutchinson’s Incisors and Moons Molars
(it’s giving MIH)
How do moon molars or Hutchinson’s incisors occur in congenital syphilis?
The tooth germ is invaded by spirochaetes.
How is syphilis diagnosed?
Serology
Which antibiotics would be given to treat syphilis?
High dose penicillin or erythromycin/tetracycline if allergic.
Treatment for angular chelitis.
Miconazole cream for mild infection.
OR
Fusidic acid ointment if there is evidence of staph aureus infection.
What treatment should be provided if angular chelitis is unresponsive?
(another tx with the existing)
Hydrocortisone with miconazole cream.
(hydrocortisone = corticosteroid)
What is NEOPLASIA?
The new and abnormal development of cells that may be benign or malignant?
Which virus is associated with Kaposis Sarcoma?
HHV 8 (human herpes virus 8)
Describe the presentation of Kaposis Sarcoma?
Pigmented neoplasm which is non-painful, slightly modulated lesion of the oral mucosa.
Name as many possible causes of burning mouth syndrome as you can.
- xerostomia
- nutritional deficiencies
- diabetes mellitus
- medications
- acid reflux
- hormonal imbalances
- allergy
- anaemia
- inflammatory conditions (e.g: lichen planus)
What is angular chellitis and its cause?
Fissuring / cracking at the corners of the mouth.
- caused by a localised infection of both bacteria and fungi seen with systemic conditions/change in local environment.
What is the topical antiseptic used for RAS?
Chlorhexidine Gluconate (mouthwash)
Topical analgesic for RAS
Benzydamine Hydrochloride (mouthwash) -
difflam
3 Controlled Drugs Prescribed on the NHS
- temazepam
- diazepam
- dihydrocodeine
