Oral Health and Disease Flashcards
What is geographic tongue?
Erythaema migrans
Common autosomal dominant disorder
Migratory areas of depapillation on the dorsum of the tongue
What are the symptoms of geographic tongue?
Generally asymptomatic
May be painful on eating spicy foods
What is lichen planus?
Mucocutaneous disorder with likely immunological aetiology
How might lichen planus present?
Pruritic skin rash on wrists and shins
Areas of white striae and ulceration affecting tongue and buccal mucosa
What is the likely cause of a smooth, sore, red tongue with soreness and cracking at the corners of the mouth in a patient being investigated for a RIF mass?
Iron deficiency
What is the likely cause of an inflamed palate with white speck and a smooth red tongue in an asthmatic?
Thrush (oral candidiasis)
What is the most likely cause of a right sided pain preceding a vesicular rash on the right side of the check and right side of the palate in an HIV positive patient?
Shingles (Herpes Zoster Virus) affecting the trigeminal nerve
What is the most likely cause of a two year history of up to five painful oral ulcers at one to two month intervals in an otherwise well schoolgirl?
Recurrent oral ulceration
What is Behcet’s Disease?
A recurrent multi-system disorder associated with immunologically mediated vasculitis
Characterised by recurrent urogenital ulceration, ocular disease alongside cutaneous, joint, neurological and vascular involvement
What is Erythema multiforme?
Immunologically mediated mucocutaneous disease
Characterised by numerous target or iris lesions with a central blister affecting the hands and feet
May have painful oral erosions and crusted lips
What can trigger Erythema multiforme?
Herpes simplex virus HIV Hep B Mycoplasma pneumoniae Drugs Malignancy
What is the most likely cause of a small papule on the upper lip which rapidly break down into a large painless indurate ulcer in a businessman returned from an extended period of overseas travel?
Syphilis
What can ulceration in the mouth be a sign of?
Recurrent aphthous stomatitis (RAS)
Tumour
Trauma
Infection
What might slump in the mouth be a sign of?
Hyperplasia
Tumour
Infection
Dental Abscess
What might a white patch in the mouth be a sign of?
Vascular
Immune
Dysplasia
What might other pigmented lesions in the mouth be a sign of?
Amalgam tattoo
Drugs
Melanoma
Why might dry mouth occur?
Lack of saliva = dehydration
Salivary gland disease = Sjogrens syndrome, radiotherapy
Diabetes
Diuretics
How might oral disease present in iron deficiency?
Recurrent oral ulceration Oral dysaethesia Oral candida Angular cheilitis Smooth tongue
Why might iron deficiency occur?
Reflection of systemic low tissue iron stores
GI bleeding
Excess menstrual loss
Poor diet
Malabsorption
Malignancy - Intestinal polyps, colorectal carcinoma
Which haematological disorders may have oral manifestations?
Anaemia Haematinic deficiencies (Vit B12, Folate, Iron)
How might bleeding disorders (e.g. leukaemia) present orally?
Spontaneous oral mucosal bleeding (usually around teeth and gums)
What systemic disease might cause RAS to present orally?
Anaemia
Haematinic Deficiency
What is orofacial granulomatosis?
Swelling of lips, cheeks
Angular cheilitis
What might cause orofacial granulomatosis?
Allergy (food additives and preservatives)
Crohn’s Disease
Sarcoidosis
How might Crohn’s Disease present orally?
Obstruction of lymphatics gives orofacial granulomatosis Mucosal oedema gives "cobblestoning" Perforation Oral ulceration Mucosal tags
How can Crohn’s disease result in oral manifestations?
Directly
Deficiency
How might GORD present orally?
Dental enamel erosion
Mucosal irritation and fibrosis
How might peptic ulcer disease present orally?
No direct effects
Indirect effects secondary to iron deficiency, vomiting (pyloric stenosis)
How might Coeliac Disease present orally?
Secondary to malabsorption, giving recurrent oral ulceration
Adult onset gives new cases of RAS
Gluten free diet is curative
How might Ulcerative Colitis present orally?
RAS
Oral effects of drug therapy
Oral lesions resolve with colectomy
How might Type II Diabetes present orally?
Thrush - acute pseudomembranous candidosis
more prone to infection
What are some dermatological conditions which can also present orally?
Lichen planus/lichenoid reactions
Pemphigus
Pemphigoid
Erythema Multiforme
What is lichen planus?
A condition affecting oral mucosa, skin, scalp, nails, genitals and oesophagus
Most patients have both skin and oral involvement
What is mucous membrane pemphigoid?
A condition affecting oral mucosa, conjuctiva, genital mucosa, nasal mucosa and skin
How does mucous membrane pemphigoid cause eyesight deterioration?
Blisters abd vesicles breakdown to form ulcers
Thes heal with scarring, which can lead to loss of sight if found at conjugtiva
Which rheumatological conditions can present orally, and how?
Primary - e.g. Sjogren’s Syndrome
Secondary - e.g. accompanying connective tissue disorder like rheumatoid arthritis
Dry mouth and/or dry eyes
What are some of the oral manifestations of HIV?
Candida Oral ulceration Kaposi's sarcoma Herpes lesions "Hairy" leukoplakia Warts Servere gingivitis Bone loss
What are some of the facial presentations of HIV?
Kaposi’s sarcoma
Cervical lymphadenopathy
Angular chelitis
Herpes zoster
What can cause oral cancer?
Tobacco and/or Alcohol Diet and nutrition HPV UVL Candida (Syphilis/Dental factors)
What kinds of tobacco can lead to oral cancer?
Reverse smoking Bidi smoking Tobacco chewing Skoal Bandits Water pipe
What dietary factors are a risk for oral cancer?
Low vitamin A
Low vitamin C
Low iron
Which types of HPV have links to oral cancer?
16 and 18
How does the prognosis of HPV associated oropharyngeal cancer compare to that of non HPV associated?
Prognosis is better in HPV associated
Where are high risk sites for oral cancer?
Soft (on keratinising sites) =
Ventral tongue
Floor of mouth
Lateral tongue
Rarer in UK =
Dorsal tongue
Hard palate
Asia =
Buccal mucosa
What are some potentially malignant oral lesions?
Erythroplakia Erythroleukoplakia Leukoplakia Erosive lichen Plans Submucous fibrosis Dyskeratosis congenita
What ar the warning signs for oral cancer?
Red/white/red and white lesion Ulcer Numb feeling Unexplained pain in mouth or neck Change in voice Dysphagia
What are other orofacial manifestations of cancer?
Numb lip or face Drooping eyelid or facial palsy Fracture of mandible Double vision Blocked or bleeding from nose facial swelling
What four questions should be asked to patients with a suspicious oral lesion?
How long has it been there?
Is it painful?
Does the patient smoke or drink?
What colour is it?
